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Quiz Session - Attempts With Random Questions

NCLEX-PN Exam Questions

Page 8 of 50

141.

You are preparing your patient's a.m. insulin. The patient is on Novolin R and NPH insulin. When preparing these insulins you should:

  • Draw up the Novolin R before drawing up the NPH

  • Draw up the NPH before drawing up the Novolin R

  • Draw them up in separate syringes--these insulins cannot be mixed in the same syringe

  • It does not matter which one you draw up first

Correct answer: Draw up the Novolin R before drawing up the NPH

Novolin R can be mixed with NPH insulin right before use. When you are mixing Novolin R insulin with NPH insulin, always draw the Novolin R (clear) insulin into the syringe first.

142.

The nurse is caring for a patient with a hearing impairment. Which approach should the nurse take to best facilitate communication? 

Select all that apply.

  • Decrease background noise

  • Face the patient and ensure there is plenty of light in the room

  • Speak slowly and clearly

  • Speak directly into the impaired ear

  • Speak loudly

When beginning a conversation with a hearing-impaired patient, face him or her, and ensure the room is well-lit to assist with lip-reading. Ensure background noise is reduced (turn off or lower the volume of television or radio, for example). Speak in a normal voice, slowly and clearly. Avoid shouting, and if the patient does not seem to understand what is being said, express it differently or use written words. Moving closer to the patient and toward the better ear may facilitate communication, but avoid talking directly into the impaired ear.

143.

A Schedule II controlled substance is one that:

  • Has a high potential for abuse with the possibility for severe psychological or physical dependence with abuse

  • Has a low potential for abuse with the possibility for mild psychological or physical dependence with abuse

  • Has a moderate potential for abuse with the possibility for moderate psychological or physical dependence with abuse

  • Has the lowest potential for abuse and may be prescribed by a pharmacist

Correct answer: Has a high potential for abuse with the possibility for severe psychological or physical dependence with abuse

Controlled substances are divided into categories specific to their potential for abuse and the potential for psychological or physical dependence with abuse. The categories range from I to V with I being substances that are illegal in the United States and V being substances that have a very low potential for abuse and may be prescribed by a pharmacist. A Schedule II controlled substance (e.g., morphine sulfate) has a high potential for abuse with the possibility for severe psychological or physical dependence with abuse.

144.

You and another nurse are preparing to change the tube on a patient with a tracheostomy. You know that:

  • An obturator helps to guide the tube and protects the stoma during insertion of the new tube

  • Changing a tracheal tube on patients with a long-standing tracheostomy is a sterile procedure

  • Suction and oxygen are not necessary to change a tube--they are only required when suctioning

  • The new tube should be inserted at a downward and outward angle

Correct answer: An obturator helps to guide the tube and protects the stoma during insertion of the new tube

The obturator has rounded edges and serves as a guide for the tracheostomy tube. The procedure is sterile in patients with a new trach; clean technique is sufficient for patients who have a long-term tracheostomy. Suction and oxygen should always be available when working with a tracheostomy. A new tube should be inserted at an upward and inward angle.

145.

A nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 3.2. Which of the following would the nurse note on the electrocardiogram as a result of the lab value?

  • U waves

  • Absent P waves

  • Elevated T waves

  • Elevated ST segment

Correct answer: U waves

A serum potassium level lower than 3.5 indicates hypokalemia. Potassium deficiency is a common electrolyte imbalance and is potentially life threatening. EKG changes include inverted T waves, ST segment depression, and prominent U waves.

146.

The nurse is caring for a patient who is connected to continuous telemetry. The central monitor at the nurse's station begins alarming and reads "V fib." Upon entering the room, the patient is sitting in the bed, talking on the phone. The nurse's initial action should be:

  • Check the leads on the patient's skin

  • Call a code

  • Call the physician to report v fib

  • Disconnect the patient from telemetry entirely

Correct answer: Check the leads on the patient's skin

When an alarm sounds at a central station, it is important for the nurse to always go into the patient's room and conduct an assessment. If the patient is awake and alert but the monitor is reporting v fib (ventricular fibrillation), the nurse should first check the leads on the patient's skin to ensure they are intact. Malfunction of the equipment and connections can lead to incorrect rhythm reports. 

147.

You suspect that another licensed practical nurse is verbally abusing a client. What should you do first?

  • Report your suspicions to the nurse in charge

  • Tell the nurse to stop abusing the client

  • Nothing, because you are not sure that the abuse is occurring

  • Call the client’s family members

Correct answer: Report your suspicions to the nurse in charge

Nurses are legally mandated to report all abuse and neglect when they are suspicious that it is occurring. Nurses do not have to be certain about it. Mandated reporters are provided immunity from civil and criminal liability as a result of making a report of any form of abuse, provided that the report was made for a valid reason.

148.

When describing fetal circulation, which of the following statements is/are accurate about the ductus arteriosus?

Select all that apply.

  • Connects the pulmonary artery to the aorta

  • One of three shunts used in the fetal circulation to direct blood that needs to be oxygenated, bypassing the lungs and liver

  • Connects the umbilical vein to the inferior vena cava, bypassing the liver 

  • Is an opening between the right and left atria of the heart

  • Connects the superior vena cava to the aorta, bypassing the lungs

The fetal circulatory system uses three shunts to direct the flow of blood (bypassing the lungs and liver) that needs to be oxygenated. The ductus arteriosus moves blood from the pulmonary artery to the aorta. The foramen ovale moves blood from the right atrium of the heart to the left atrium, bypassing the lungs. The ductus venosus allows highly oxygenated blood from the umbilical vein to bypass the liver, flow to the inferior vena cava, and then to the right atrium of the heart. Shortly after birth, the closure of the ductus arteriosus, ductus venosus, and foramen ovale completes the change of fetal circulation to newborn circulation.

None of these three shunts connect the superior vena cava to the aorta. 

149.

The nurse is providing education to the family of a child newly diagnosed with asthma. The nurse should discuss which of the following clinical manifestations as early warning signs of an asthma attack? 

Select all that apply.

  • A feeling of irritability and restlessness

  • Easily fatigued

  • Chest tightness

  • Retractions

  • Cyanosis

Early warning signs that an asthma attack is imminent are as follows: the attack begins with irritability, restlessness, headache, fatigue, and/or chest tightness. Just before the attack, the child may have localized itching at the front of the neck or over the upper part of the back. This is generally followed by an irritable, hacking, nonproductive cough caused by bronchial edema and chest retractions. The cough can become rattling as secretions stimulate the cough and production of frothy, clear, gelatinous sputum occurs. Cyanosis may manifest (often around the mouth and the nail beds), and the child will not be able to speak in full sentences but rather short, broken phrases. Once the attack has progressed to cyanosis and retractions, medical treatment is required.

150.

The most common sexually transmitted disease in the United States is:

  • Chlamydia

  • Trichomonas

  • Herpes simplex virus

  • Gonorrhea

Correct answer: Chlamydia

The most common sexually transmitted disease (STD) in the United States is chlamydia. Around five million people in the US contract the disease annually. In addition, it is estimated that around one billion health care dollars are spent each year on the diagnosis and treatment of chlamydia. Providing education to men and women about symptoms, transmission, and prevention is essential.

151.

The licensed practical nurse (LPN) is preparing the equipment for a patient who is in need of a blood transfusion. The LPN adds extension tubing to the regular IV tubing before initiating the blood transfusion for which of the following patients?

Select all that apply.

  • A child

  • A restless patient

  • A patients with special mobility needs

  • An obese patient 

  • A hearing-impaired patient 

Extension tubing can be added to an IV tubing set to provide extra length to the tubing. Extension tubing should be added to the IV tubing set for children, patients who are restless, or patients who have special mobility needs. 

It is not necessary to add extension tubing to the IV tubing set of a patient who is obese or hearing-impaired.

152.

You are teaching a health assessment class. The lab involves learning how to examine the abdomen. In what order should you teach your students to palpate the abdomen if the patient is complaining of right lower quadrant pain?

  • Begin palpation in the left upper quadrant

  • Begin palpation in the right lower quadrant

  • Begin palpation in the left lower quadrant

  • Begin palpation in the right upper quadrant

Correct answer: Begin palpation in the left upper quadrant

Palpation should begin in the abdominal quadrant furthest from where the pain is occurring. Work in the direction of the pain and note where the pain begins.

153.

The nurse is caring for a burn injury patient who just underwent an autografting procedure to the right lower leg. When providing care, which interventions should the nurse implement? 

Select all that apply.

  • Elevate and immobilize the graft site

  • Avoid weight-bearing to the affected leg

  • Lubricate the healing skin with prescribed agents

  • Cover the site with a sterile gauze pad

  • Expose the site to sunlight to expedite healing

Autografting provides permanent wound coverage, and involves the surgical removal of a thin layer of the patient's own unburned skin, which is then applied to the excised burn wound. When caring for the graft site, the nurse should elevate and immobilize the extremity, keeping the site free from pressure (do not cover the graft site with anything, as it needs to be open to air in order to properly heal). Avoid weight-bearing and, when the graft takes, roll a cotton-tipped applicator over the graft to remove exudate (can lead to infection and prevent graft adherence if not removed). Monitor the graft for foul-smelling drainage, increased temperature, increased white blood cell count, hematoma formation, and fluid accumulation. Reinforce instructions to the patient to protect the affected area from sunlight (can damage the site and inhibit healing process). Apply lubricating lotions or ointments as prescribed to the healing skin.

154.

You are the nurse who will be administering all medications to a group of 30 residents on your unit. You know most of the residents because they have been on your unit for some time; however, there are about seven residents you do not know as well as the others. How can you safely administer these medications to the group in a timely manner?

  • Use at least two unique identifiers for each resident in the group

  • Use at least two unique identifiers for the seven residents with whom you are not completely familiar

  • Use at least two unique identifiers for the seven residents with whom you are not completely familiar and simply ask the other residents for their first and last names

  • Check the photographs of all residents before you begin the medication administration so that you can remember what they look like

Correct answer: Use at least two unique identifiers for each resident in the group

Two unique identifiers, such as first/last name, complete date of birth, a photograph, or the last four numbers of the resident's social security number, must be used to identify all patients and residents before medications are given. This identification process prevents medication errors and must be performed whether you know the resident/patient or not.

155.

Biological agents that are of concern for use in bioterrorism include all of the following except:

  • Cyanide

  • Smallpox

  • Pneumonic plague

  • Anthrax

Correct answer: Cyanide

Bioterrorism is defined as the use of biological agents to create fear and threat. Bioterrorism is the most likely form of terrorist attack to occur in the United States. Although terrorists could use any agent, officials are most concerned with biological agents such as anthrax, smallpox, pneumonic plague, botulism, and viral hemorrhagic fevers.

156.

The nurse is caring for an infant in a cast for a diagnosis of congenital clubfoot. The nurse notes that the toes on the infant's right foot are pale and slightly edematous, and when the nurse passively moves the toes, the infant cries. 

Which of the following interventions are appropriate at this time?

Select all that apply.

  • Notify the RN immediately

  • Prepare to assist with removal of the cast

  • Continue to monitor as this is a normal finding

  • Reassess the infant's extremities in one hour to determine if further action should be taken

  • Elevate the infant's right leg on several pillows to help alleviate the swelling

These are signs of circulatory impairment and possible compartment syndrome, a condition in which pressure increases in a confined anatomical space. This leads to decreased blood flow, ischemia, and dysfunction of these tissues. If any of the above signs are present, or if the patient experiences increased pain, erythema, numbness and tingling, coolness, decreased sensation or mobility, or diminished pulses, the RN should be immediately notified for further assessment. The RN will assess the child and notify the primary health care provider (PHCP) immediately because of the risk of tissue ischemia and necrosis if neurovascular impairment is noted. Bivalving or cutting of the cast is indicated if circulatory impairment occurs.

157.

A patient has just received a diagnosis of asthma. In obtaining a health history from the patient, the nurse discovers the patient has peptic ulcer disease, which is a contraindication to the initiation of bronchodilator medication. 

In what other conditions would the use of a bronchodilator, such as albuterol, be contraindicated? 

Select all that apply.

  • Cardiac dysrhythmias

  • Hyperthyroidism

  • Uncontrolled seizure disorders

  • Hypotension

  • Diabetes mellitus

Bronchodilators relax the smooth muscle of the bronchi and dilate the airways of the respiratory tract, making air exchange and breathing easier for the patient with acute and chronic asthma, acute bronchospasm, bronchitis, and restrictive airway diseases. They are, however, contraindicated in individuals with hypersensitivity, peptic ulcer disease, severe cardiac disease and dysrhythmias, hyperthyroidism, or in patients with uncontrolled seizure disorders. 

Bronchodilators are used with caution in those with hypertension, diabetes mellitus, or narrow-angle glaucoma.

158.

Your patient has been crossmatched in preparation for a blood transfusion. Your patient is blood type O, RH negative (O-). Your patient could receive blood from which donor blood type?

  • O- only

  • O+ or O-

  • Neither O- nor O+

  • AB+

Correct answer: O- only

The patient who is O- can only receive blood from an O- donor. People with O- blood types are considered universal donors, while people with blood type AB+ are considered universal recipients (can receive blood from donors of all blood types).

159.

Your client has been diagnosed as having the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which nursing intervention is appropriate for the care of this client?

  • Observation for signs of cerebral edema

  • Encouragement of oral fluid intake

  • Monitoring for signs of hypernatremia

  • Placement of a urinary catheter

Correct answer: Observation for signs of cerebral edema

One of the complications of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is cerebral edema. Other complications include pulmonary edema and hyponatremia. Fluids are restricted rather than encouraged, and a urinary catheter should not be routinely placed because of the risk of catheter-related urinary tract infections.

160.

Which of the following clinical manifestations would cause the nurse to suspect a patient may have a diagnosis of systemic lupus erythematosus (SLE)?

Select all that apply.

  • Malar rash

  • Joint edema and tenderness

  • Weakness, malaise, and fatigue

  • Negative antinuclear antibody (ANA) test

  • Weight gain

SLE is a chronic, progressive, systemic inflammatory disease that can cause major organs and systems to fail. The body is unable to recognize its own cells as a part of itself. Common manifestations include a malar rash (also known as a butterfly rash) of the face, erythema of the palms, fever, weakness, malaise, fatigue, joint pain, and stiffness (particularly in the mornings). 

Laboratory values reveal a positive ANA test, elevated sedimentation rate (ESR), and elevated C-reactive protein (CRP). For the patient with SLE, monitor their blood urea nitrogen (BUN) and creatinine level frequently for signs of renal impairment. Weight loss and anorexia are common with SLE (not weight gain).

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