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Quiz Session - Attempts With Random Questions

NCLEX-PN Exam Questions

Page 5 of 50

81.

Your patient has been told that he has cancer requiring surgery and chemotherapy. The patient states that the doctors are mistaken and his symptoms must be due to another cause. The patient's behavior is an example of:

  • Denial

  • Dissociation

  • Displacement

  • Regression

Correct answer: Denial

Denial is the complete rejection of an idea, thought or feeling. Dissociation is losing track of time and/or person and finding another "self" to continue in the moment. Displacement is redirecting feelings toward another target. Regression is reverting to an old (usually infantile) behavior to ventilate one's feelings.

82.

All of the following are complications associated with alcohol abuse except:

  • Vitamin B toxicity

  • Wernicke's encephalopathy

  • Thiamine deficiency

  • Gastritis

Correct answer: Vitamin B toxicity

Long-term alcohol abuse is associated with a number of negative sequelae. Vitamin B deficiency (not toxicity nor excess), thiamine deficiency, Wernicke's encephalopathy, gastritis and hepatitis, brain disorders, cardiac disorders, peripheral neuropathy, pancreatitis, and anemia are some of the sequelae associated with chronic alcohol abuse. It is important to appropriately monitor and treat patients for complications associated with chronic alcohol abuse, because early identification can help to reduce further problems.

83.

To avoid infection with toxoplasmosis, the nurse should instruct the pregnant woman to do which of the following?

Select all that apply.

  • Avoid undercooked or raw meat

  • Wash fruits and vegetables thoroughly

  • Avoid contact with a cat litter box

  • Avoid kissing young children on the mouth or putting their pacifier in your mouth

  • Avoid breastfeeding because this virus can be transmitted through breast milk

Toxoplasmosis is caused by an infection with the protozoan intracellular parasite Toxoplasma gondii. It is most commonly transmitted to the mother through the consumption of raw meat (especially pork, beef, lamb), or the improper handling of the cat litter (feces) of infected cats. The mother then can transmit the virus to her baby via the placenta. The nurse should instruct the pregnant woman to avoid poorly cooked or raw meat, wash fruits and vegetables thoroughly, and wear gloves when gardening (and avoiding garden areas frequented by cats). A blood test confirms the diagnosis of congenital toxoplasmosis in the infant, and treatment involves antibiotics and/or antimalarial agents. 

Instruct patients to avoid kissing young children on the mouth when teaching about how to prevent cytomegalovirus (a virus that belongs to the herpes simplex virus group), as the virus can be transmitted via saliva. Breastfeeding should be avoided in the HIV positive mother because it can be transmitted through breast milk to the infant.

84.

You are supervising a new nurse's aid, who is administering her first enema to your shared patient. Which of the following statements by the aid indicates inadequate knowledge regarding the administration of enemas?

  • "I will position the patient on her right side with her knees drawn up to her abdomen."

  • "I will warm the enema prior to administration to promote comfort and decrease abdominal cramping."

  • "I will insert the enema into the rectum to a depth of approximately 10 cm."

  • "I will expel air from the enema prior to administration."

Correct answer: "I will position the patient on her right side with her knees drawn up to her abdomen."

Patients should be positioned on their left side with their knees drawn up to their abdomen. This is due to the anatomical structure of the sigmoid colon and also helps facilitate the flow of solution into the colon.

85.

Of the following patient scenarios, which would be most appropriate for the licensed practical nurse (LPN) to delegate to an unlicensed assistive staff member?

  • A patient who was admitted four days ago with pneumonia and needs bed-to-chair transfer

  • A patient who underwent a carotid endarterectomy this morning and needs a dressing change

  • A patient with lung cancer who is complaining of pain and asking for narcotic medication

  • A patient who is combative and in need of physical restraint measures

Correct answer: A patient who was admitted four days ago with pneumonia and needs bed-to-chair transfer

In delegating patient care to unlicensed assistive personnel, the licensed practical nurse (LPN) should ensure they delegate the right task to the right person. It is important to make note of whether the task can be legally delegated to unlicensed personnel. Of the patient scenarios, the patient who was admitted four days ago and is in need of assistance with transferring from bed to chair would be most appropriate for the unlicensed assistive staff member. Initial dressing changes, medication administration, and application of physical restraints are interventions that should be completed by licensed nursing staff.

86.

The nurse is caring for a patient following hysterectomy. Which interventions should the nurse plan to implement? 

Select all that apply.

  • Monitor vaginal bleeding; notify RN if patient saturates more than one pad per hour

  • Assist with coughing and deep-breathing exercises

  • Assist with range-of-motion (ROM) exercises in bed and limit early ambulation

  • Discourage pain medication as it increases the risk of constipation

  • Reinforce postoperative instructions to encourage tub baths for the first week following surgery

Hysterectomy is the removal of all or part of the uterus; a vaginal approach is most commonly performed. Postoperative care includes monitoring vaginal bleeding and reporting to the RN and PHCP more than one saturated pad per hour (may indicate excessive bleeding). In addition, vital signs and incisional site should be closely monitored for signs of infection. Coughing and deep-breathing exercises should be implemented, and ROM should be performed to assist with early ambulation (do not limit early ambulation); the sooner the patient is able to get out of bed, the better. 

Do not discourage the use of pain medication; though it can increase the risk of constipation, provide pain medication as prescribed. Often, a stool softener is also prescribed to help with constipation issues. Tub baths should be avoided for the first month following hysterectomy surgery (increases risk of infection). Other postoperative instructions that should be reinforced include avoiding sitting for long periods of time and climbing stairs for one month, and avoidance of strenuous activity or lifting anything over 10 to 20 pounds.

87.

Which of the following immunizations are highly recommended during pregnancy?

Select all that apply.

  • Influenza vaccine

  • Tdap vaccine

  • Rubella vaccine

  • Varicella vaccine 

  • BCG vaccine

A fetus gets passive immunity (via the placenta) from the mother during pregnancy. This immunity can then protect the newborn baby from some diseases during the first few months of life. Because of this, the pregnant woman should receive an influenza (flu) and whooping cough (Tdap) vaccine during pregnancy. The flu vaccine is the best way for a pregnant woman to protect against the flu and protect her baby for several months after birth from flu-related complications. The pregnant woman should be highly encouraged to get a flu shot anytime during each pregnancy. Whooping cough can be life-threatening for a newborn. Because of this, the CDC recommends getting a Tdap vaccine during the 27th through 36th week of each pregnancy.

Rubella vaccine is not given during pregnancy because the live attenuated virus may cross the placenta and present a risk to the developing fetus. It can be delivered in the postpartum period (before hospital discharge), via the subcutaneous route if needed. 

Varicella and BCG vaccines are not recommended for pregnant women.

88.

Cancer occurs when:

  • A cell's genetic mutations are defective and cannot induce cell death 

  • A cell rapidly reproduces and divides

  • A cell is deficient in nutrients and develops defects

  • A cell becomes contaminated with a carcinogen and infects other cells

Correct answer: A cell's genetic mutations are defective and cannot induce cell death 

Cancer occurs when a cell's genetic mutations are defective and therefore cannot induce cell death, also known as apoptosis. In the absence of apoptosis, cell growth becomes uncontrolled and invades various systems of the body, leading to various levels of dysfunction. Uncontrolled cell growth masses are also known as tumors.

89.

When dealing with an anxious patient, which of the following interventions should the nurse implement immediately?

Select all that apply.

  • Decrease environmental stimuli

  • Provide a calm and quiet environment

  • Encourage the patient to describe their feelings

  • Promote relaxation techniques such as controlled breathing or guided imagery

  • Listen to the patient

The immediate nursing actions for the patient experiencing anxiety are to decrease stimuli in the nearby area and provide a calm and quiet environment. Always stay with the patient to promote safety and security, and do not force the patient to have contact with the phobic object or situation. 

Next, ask the patient to identify and describe feelings, listen for expressions of helplessness and hopelessness, and promote relaxation techniques (controlled breathing and guided imagery are both helpful ways to relieve anxiety).

90.

What is the correct sequence of Sigmund Freud's levels of normal development, beginning with the earliest phase and ending with the last phase of psychological development?

  • The oral, anal, phallic, latency, and genital stages

  • The oral, phallic, latency, anal, and genital stages

  • Preoperational, sensorimotor, concrete operations, and formal operations

  • Sensorimotor, preoperational, concrete operations, and formal operations

Correct answer: The oral, anal, phallic, latency, and genital stages

One can be fixed or fixated at one of these stages. For example, an infant may be fixated on the oral stage throughout his lifetime even though he should progress without fixation to the last, or genital, stage.

91.

After pressing the "ANALYZE" button on an AED, what should you do next?

  • Ensure that no one is touching the patient

  • Resume CPR

  • Provide 2 breaths with a pocket mask

  • Check for a pulse

Correct answer: Ensure that no one is touching the patient

After pressing the "ANALYZE" button, you need to ensure that no one is touching the patient. This may delay analysis of the victim's rhythm, which may in turn delay the shock (if indicated).

92.

Which ethical term is correctly and accurately paired with its description?

  • Nonmaleficence: “Do not harm” as in the Hippocratic Oath

  • Beneficence: “Do not harm” as in the Hippocratic Oath

  • Justice: Truthfulness and honesty

  • Fidelity: Fairness and equality

Correct answer: Nonmaleficence: “Do not harm” as in the Hippocratic Oath

Nonmaleficence is “Do not harm” as stated in the historical Hippocratic Oath. Harm can be intentional or unintentional. Beneficence is doing good; justice is fairness to all; and fidelity is being faithful to one’s promise.

93.

Your palliative patient can no longer take morphine in pill or liquid form due to inability to swallow effectively. What other route can be used to deliver morphine?

  • All of these

  • Intramuscular

  • Subcutaneous

  • Intravenous

Correct answer: All of these

Morphine can be given by a variety of routes. It may be given continuously via the subcutaneous or intravenous routes, or intermittently by all of these routes.

94.

The nurse has just admitted a patient with a suspected myocardial infarction (MI) and a history of active peptic ulcer disease (PUD). Which of the following medications would the nurse expect the primary health care provider (PHCP) to order? 

Select all that apply.

  • Sublingual nitroglycerin 

  • Oxygen by nasal cannula 

  • Morphine intravenously 

  • Aspirin by mouth

  • Clopidogrel by mouth

Oxygen via nasal cannula, IV morphine, sublingual nitroglycerine, PO aspirin, and PO thienopyridines (clopidogrel) are all appropriate interventions for a patient who is experiencing an MI. However, if the patient has a history of an active peptic ulcer, they should not be considered a candidate for aspirin or clopidogrel, because of the antiplatelet effects of both medications, which could possibly lead to more gastrointestinal bleeding.

95.

In a newborn diagnosed with esophageal atresia, which of the following signs and symptoms are often present?

Select all that apply.

  • Coughing and choking during feedings

  • Unexplained cyanosis

  • Abdominal distention

  • Anemia from blood loss

  • Peristaltic waves visible from left to right across the epigastrium during or immediately after a feeding

Esophageal atresia and tracheoesophageal fistula (TEF) are birth defects of the esophagus; the esophagus terminates before it reaches the stomach, ending in a blind pouch, and/or a fistula is present that forms an unnatural connection with the trachea. Often the infant will exhibit the "3 Cs" - coughing and choking during feedings and unexplained cyanosis. In addition, there may be frothy saliva in the mouth and nose and excessive drooling with feedings. The infant will regurgitate and vomit shortly after feedings, exhibit increased respiratory distress during and after feedings, and often have severe abdominal distention. 

Anemia from blood loss can occur with complications related to gastroesophageal reflux (GERD). Pyloric stenosis will present with visible peristaltic waves across the epigastrium during or immediately following a feeding.

96.

The licensed practical nurse is assessing a patient's skin turgor and finds that it takes longer than normal for the skin to return to its place after being gently pinched. What are the possible indications of this assessment finding?

Select all that apply.

  • Dehydration

  • Extreme weight loss

  • The presence of pitting edema

  • Jaundice

  • Internal bleeding

A normal skin turgor (elasticity of the skin) test means that once the skin is gently pinched, it recoils almost immediately when released. If a patient is assessed to have poor skin turgor (it takes longer than 2 seconds for the pinched skin fold to return to normal), possible causes include dehydration, weight loss, heat exhaustion, or hypovolemic shock. 

Pitting edema is assessed by the examiner applying pressure to a swollen area of skin (often feet, ankles, lower extremities), for about 10-15 seconds to check for lasting indentation. Jaundice and internal bleeding are not a cause of poor skin turgor. 

97.

Which of the following is considered a primitive neurological reflex?

  • The Moro reflex

  • The plantar reflex

  • Pupil reflexes to light and accommodation

  • The gag reflex

Correct answer: The Moro reflex

The Moro, or startle, reflex is elicited by sudden noises and other sudden changes like environmental temperature. It is considered to be a primitive or infant reflex because it is present at birth but disappears in a couple of months under normal circumstances. Other primitive reflexes include the parachute reflex, the Galant reflex, and the tonic neck or fencing reflex.

98.

You are working in home health care as a licensed practical nurse. Your clients are a husband and wife. The husband is visually impaired and deaf. The wife is an elderly woman who has had a left-sided stroke and has chronic obstructive pulmonary disease and is using oxygen PRN. Both clients smoke cigarettes. What is the greatest safety hazard that this couple may encounter?

  • A catastrophic explosion

  • Fire

  • Food borne illness

  • A fall

Correct answer: A catastrophic explosion

Oxygen therapy is hazardous, particularly in a home where the client(s) smoke cigarettes. Although a fire could occur, the greatest safety risk is a catastrophic explosion, which is often instantaneous and not escapable.

99.

A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction?

  • Variable decelerations

  • Late decelerations

  • Early decelerations

  • Short-term variability

Correct answer: Variable decelerations

Variable decelerations occur if the umbilical cord is compressed, reducing blood flow between the placenta and the fetus. Early decelerations result from pressure on the fetal head during a contraction. Late decelerations are an ominous pattern in labor because they suggest uteroplacental insufficiency during a contraction.

100.

The nurse is providing medication education to a patient just prescribed an MAOI (monoamine oxidase inhibitor) to treat depression. The nurse explains the need to avoid which of the following tyramine-containing foods, because they can cause a hypertensive crisis when taking an MAOI? 

Select all that apply.

  • Avocados

  • Fermented cheeses

  • Caffeine

  • Chicken and beef liver

  • Eggs

  • Whole wheat breads and pastas

The patient taking an MAOI needs to be taught which foods contain tyramine. Consuming tyramine-containing foods when taking an MAOI can cause hypertensive crisis. 

The nurse should provide the patient with a list of tyramine-containing foods that should be avoided. Tyramine is found mainly in foods that are fermented, aged, or spoiled, and eating tyramine-rich foods while taking an MAOI can cause side effects such as high blood pressure, headache, heart palpitations, nausea, vomiting, visual disturbances, and confusion, and can lead to hypertensive crisis. Even a small amount of tyramine can increase blood pressure and the force and/or rate of heart contractions. Avocados, bananas, caffeine, and chicken or beef liver are all on the foods-to-avoid list. 

Eggs and whole wheat breads and pastas are recommended in moderation, not avoided.

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