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Quiz Session - Attempts With Random Questions

NCLEX-RN Exam Questions

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1.

The nurse should expect a patient with hyperthyroidism (Graves' disease) to report which health concern(s)?

Select all that apply.

  • Weight loss

  • Diarrhea

  • Hypertension

  • Decreased appetite

  • Facial edema

Hyperthyroidism results from an oversecretion of thyroid hormones (T3 and T4) and resulting low TSH (thyroid-stimulating hormone). The body is in a hypermetabolic state, resulting in weight loss, cardiac dysrhythmias and palpitations, diarrhea, hypertension, enlarged thyroid gland (goiter), heat intolerance, nervousness and irritability, and an increased appetite. 

Hypothyroidism causes generalized puffiness around the eyes and face (myxedema).

2.

The nurse calls the physician regarding a new medication order because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the physician, and the medication is due to be administered. Which action should the nurse take?

  • Contact the nursing supervisor

  • Administer the dose prescribed

  • Hold the medication until the physician can be contacted

  • Administer the recommended dose until the physician can be located

Correct answer: Contact the nursing supervisor

If the physician writes an order that requires clarification, the nurse's responsibility is to contact the physician for clarification. If there is no resolution regarding the order because the physician cannot be located or because the order remains as it was written after talking to the physician, the nurse should then contact the nurse supervisor for further clarification as to what the next step should be.

3.

A patient who was just admitted to a long-term care facility informed his nurse that he wanted to donate one of his kidneys to his son for a kidney transplantation. The nurse understands that the patient's request is governed under which of the following?

  • The Uniform Anatomical Gift Act

  • The Patient Self-Determination Act

  • The Health Insurance Portability and Accountability Act

  • The Patient's Bill of Rights

Correct answer: The Uniform Anatomical Gift Act

The Uniform Anatomical Gift Act is the act that governs the act of donating organs for transplantation.

The Patient Self-Determination Act is the act that educates patients on their rights to accept or refuse medical care. The Health Insurance Portability and Accountability Act is the act that protects patients from their personal information being shared. The Patient's Bill of Rights is the act that identifies what patients can expect and what is expected from the patient in regards to health care.

4.

You are performing discharge planning with a Native American client. The client looks down at the ground while you are speaking and does not make direct eye contact. How should you interpret this behavior?

  • This is common behavior in the Native American culture

  • The client does not want to go home

  • The client is sad to be leaving the hospital

  • The client is bored by your explanations

Correct answer: This is common behavior in the Native American culture

Making eye contact in this culture is considered rude or disrespectful; therefore, the client's behavior is normal.

5.

The nurse is caring for a patient who has a stage IV pressure ulcer. The nurse knows that before the pressure ulcer can begin heeling she must do which of the following?

  • Relieve the pressure

  • Change non-adherent dressings every 12 hours

  • Provide the patient with nutritional supplements

  • Apply topical antimicrobials as needed

Correct answer: Relieve the pressure

Before the pressure ulcer can begin healing, the nurse must relieve the pressure. If the pressure ulcer remains under pressure, it will continue to get worse.

Changing the patient's non-adherent dressings every 12 hours, providing the patient with nutritional supplements, and applying topical antimicrobials are all important to promote healing; however, relieving pressure is more important.

6.

The nurse assessed a patient who states that he experiences feelings of choking, accelerated heart rate, sweating, and trembling when he is in large crowds. Which medication would the physician most likely prescribe for this patient?

  • Fluoxetine (Prozac)

  • Methylphenidate (Ritalin)

  • Memantine (Namenda)

  • Haloperidol (Haldol)

Correct answer: Fluoxetine (Prozac)

The physician would most likely prescribe this patient Fluoxetine (Prozac). Feelings of choking, accelerated heart rate, sweating, and trembling are all signs of panic disorder, which is an anxiety disorder. Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor, which is prescribed for panic disorders.

Methylphenidate (Ritalin) would be prescribed for attention-deficit hyperactivity disorders, not panic disorders. Memantine (Namenda) would be prescribed for dementia, not panic disorders. Haloperidol (Haldol) would be prescribed for schizophrenia, not panic disorders.

7.

Your patient has metabolic alkalosis. You would expect to see which of the following ABG results?

  • Elevated pH, bicarbonate, and carbon dioxide

  • A low pH, high bicarbonate, and high carbon dioxide

  • A high pH, low bicarbonate level, and low carbon dioxide

  • A low pH, low bicarbonate levels, and low carbon dioxide

Correct answer: Elevated pH, bicarbonate, and carbon dioxide

Elevated pH, bicarbonate, and carbon dioxide typically indicate severe vomiting has altered the chemistry of the blood. Alkalotic agents, such as bicarbonates, and hyperaldosteronism are other potential causes of metabolic alkalosis.

8.

A patient is receiving a red blood cell (RBC) transfusion for sickle cell disease. The patient's transfusion started at 1:00 p.m. How long should it take for the patient's RBC transfusion to be complete?

  • The transfusion should be completed within 4 hours

  • The transfusion should be completed within 2 hours

  • The transfusion should be completed within 15 minutes

  • The transfusion should be completed within 30 minutes

Correct answer: The transfusion should be completed within 4 hours

According to the FDA, a RBC transfusion should be completed within 4 hours. The RBC transfusion needs to be infused slowly for the first 15 minutes. The administration of RBCs must begin within 30 minutes of obtaining it from the blood bank.

9.

As a nurse working on a step-down ICU unit, you have been assigned Ronald, an abdominal gunshot wound patient. He has a new colostomy bag. Which of the following statements would indicate that Ronald is not coping with his new condition?

Select all that apply.

  • "I am not touching this nasty bag." 

  • "I don't understand why I have to change it. All these nurses can do it for me."

  • "Can I try to change the bag now?"

  • "What kind of changes do I need to make to my workouts to allow for my bag?"

Ronald, as an abdominal gunshot wound victim, will require a colostomy bag for the trauma his GI tract suffered. Ronald would show signs of insufficient coping if he did not want to be active in his plan of care. 

It is normal for a new colostomy bag to make the patient anxious, but they need to be educated on the process of changing the bag, as this will be a normal part of their ADLs on release. 

10.

Which of the following are appropriate developmental considerations for a 4-year-old when administering medication? 

Select all that apply.

  • Accept aggressive behavior (within reasonable limits) as a healthy response, and provide outlets for the child

  • Provide comfort measures after the procedure

  • Explain the procedure, allowing for some control over the body and situation 

  • Encourage participation in the procedure

  • Use the opportunity to teach about how medication helps the illness/disorder

When administering medication to a preschooler (aged 3- to 5-year-old child), the following should be considered:

  • Offer a brief, concrete explanation of the procedure and then perform it
  • Accept aggressive behavior (within reason) as a healthy response, and provide outlets for the child
  • Provide comfort measures immediately after the procedure, such as touch, holding, or providing a favorite toy

The other answer options are too advanced for the preschooler and should be reserved for either the school-age child or adolescent. 

11.

A patient who underwent abdominal surgery calls the nurse because he felt "something pop open" at his incisional site after coughing. The nurse removes the dressing to reveal a loop of bowel protruding through the incision. Which nursing action(s) should the nurse take?

Select all that apply.

  • Stay with the patient, call for help, and notify the surgeon

  • Prepare the patient for surgery

  • Take the patient's vital signs

  • Place a sterile dressing and ice packs over the wound

  • Place the patient in a Trendelenburg position

Wound dehiscence is when the edges of a wound separate at the suture line, and can progress to evisceration (protrusion of the internal organs through an incision). These complications generally occur 6 to 8 days after surgery. Evisceration is considered a medical emergency. The nurse should call for help, notify the surgeon, and ask for supplies to be brought into the patient's room. Do not leave the patient unattended in this situation. Monitor vital signs and watch the patient closely for signs of shock. Place the patient in a low-Fowler's position with knees bent, and cover the wound with a sterile normal saline dressing, taking care to keep the dressing moist. Prepare the patient for surgery. Make sure to document what happened, all actions taken, and the patient's response.

12.

In severely malnourished patients who are started on parenteral nutrition (PN), the nurse should watch for evidence of:

  • Refeeding syndrome

  • Pulmonary-renal syndrome

  • Red man syndrome

  • Dumping syndrome

Correct answer: Refeeding syndrome

Severely malnourished patients who are receiving parenteral nutrition (PN) may experience and electrolyte shift commonly referred to as "refeeding syndrome" after PN is initiated. This shift can cause problems to the cardiovascular, respiratory, and neurological systems, such as shallow respirations, confusion, weakness, bleeding tendencies, and seizures. An excess of amino acids in PN may cause abnormal renal function.

Pulmonary-renal syndrome is diffuse alveolar hemorrhage plus glomerulonephritis, often occurring simultaneously, and typically caused by an autoimmune disorder.

Red man syndrome is an infusion-related reaction specific to rapid infusion of vancomycin.

Dumping syndrome is a group of symptoms, including weakness, abdominal discomfort, and sometimes abnormally rapid bowel evacuation, occurring after meals in some patients who have undergone gastric surgery.

13.

When caring for an older patient, the nurse understands that the patient is at risk for which of the following physiological changes?

Select all that apply.

  • Increased blood clotting

  • Decreased visual acuity

  • Decreased caloric needs

  • Low-pitched tones are heard more easily than high-pitched tones

  • Increased glucose tolerance

  • Increased cardiac output

The older patient is at risk for increased blood clotting and decreased protein availability for protein-bound medications, as hemoglobin and hematocrit levels average toward the lower ends of normal. Vision generally decreases with age, and the eyes require more time to adjust to changes in light, with presbyopia (farsightedness) and cataract formation more likely. Caloric needs decrease as metabolic rate is lowered, and appetite, thirst, and oral intake decrease. Gastric motility slows as well. There is often a loss of hearing ability, and low-pitched tones are heard more easily. 

Glucose tolerance is decreased, with resistance to insulin in peripheral tissues. Cardiac output is decreased as well, with decreasing efficiency of blood return to the heart.

14.

The hospital's psychiatric unit is always under lock-down, as anyone who enters or leaves the unit must have permission to do so. Around lunchtime, the nurse hears the alarm go off, which means someone must have tripped the alarm. What action should the nurse take?

  • The nurse should verify that all patients are safe and accounted for and then she should reset the alarm from the location where it was tripped

  • The nurse should reset the alarm from the front desk, as the lunch carts most likely tripped the alarm

  • The nurse should reset the alarm from the front desk and then conduct a patient head count

  • The nurse should ask another RN to do a head count while she resets the alarm from the location where the alarm was tripped

Correct answer: The nurse should verify that all patients are safe and accounted for and then she should reset the alarm from the location where it was tripped

The nurse should verify that all patients are safe and accounted for and then she should reset the alarm from the location where it was tripped. The alarm is used as a safety mechanism and when it is tripped, it alerts the staff that something isn't right and that they need to verify that everyone is safe and accounted for and then the alarm should be reset from the point at which it was triggered.

The nurse should not assume that the lunch carts tripped the alarm and she should not reset the alarm from the front desk, as the alarm needs to be reset at the location it was triggered. The nurse should not reset the alarm from the front desk and then do a head count, as she needs to verify that everyone is safe and accounted for and then reset the alarm from the location that it was triggered. The nurse should not ask another nurse to do a head count while she resets the alarm, as the patients need accounted for before the alarm is reset.

15.

Your are performing outpatient teaching for a patient who is to wear a Holter monitor for 24 hours. Which of the following instructions is incorrect?

  • "You should not exercise while wearing the monitor."

  • "Showering and swimming should be avoided."

  • "Holter monitoring can detect heart rate variabilities, abnormal rhythms, and heart beat morphology."

  • "It is important to note any symptoms you experience in the diary provided."

Correct answer: "You should not exercise while wearing the monitor."

Patients should be counseled to carry out their usual daily activities, including exercise, while wearing the monitor (with the exception of any activity that may result in the monitor becoming wet).

All other statements are correct.

16.

The nurse understands that the calciferol hormone is produced by which of the following body systems?

  • Integumentary system

  • Urinary system

  • Endocrine system

  • Reproductive system

Correct answer: Integumentary system

The calciferol hormone is produced by the integumentary system. Calciferol is vitamin D3, which is synthesized in the skin when the skin is exposed to the sun's ultraviolet rays. Skin is an organ of the integumentary system.

The calciferol hormone is not produced by the urinary system, the endocrine system, or the reproductive system.

17.

The nurse notes a serum sodium level of 153 mEq/L. Which of the following conditions are associated with this laboratory result?

Select all that apply.

  • Severe dehydration

  • Corticosteroid therapy

  • Primary aldosteronism

  • Addison's disease

  • Diabetic ketoacidosis (DKA)

Hypernatremia is an electrolyte imbalance within the body characterized by increased serum sodium levels (normal ranges from 135 to 145 mEq/L). If left untreated, hypernatremia can become life-threatening. 

Causes of this imbalance often include dehydration (a strong feeling of thirst may be an early warning sign), an increase in dietary or IV intake of sodium, renal impairment, primary aldosteronism (excessive production of the hormone aldosterone from the adrenal glands leading to potassium loss and sodium retention) and use of corticosteroid therapy. Hypernatremia is most common in young children (5 years and younger) and older adults (60 years and older). 

Both Addison's disease and DKA are causes of hyponatremia (serum sodium levels of less than 135 mEq/L).

18.

A physician orders 0.25 mg of alprazolam (Xanax) for a patient with anxiety. The pharmacy only has 500-mcg tablets in stock. How many tablets will the nurse need to administer to the patient?

  • One-half

  • Four

  • One

  • Two

Correct answer: One-half

The nurse will need to administer one-half of a tablet. A 500 mcg tablet is equivalent to 0.5 mg. Since the nurse only needs to administer 0.25 mg, she will need to administer one-half of a 0.5 mg tablet.

0.5 mg x 1/2 = 0.25 mg

19.

A nurse is treating an elderly patient whose husband passed away last year. Which of the following would show signs of ineffective coping?

Select all that apply.

  • Not completing ADLs

  • Excessive weight loss

  • Talking about her husband often

  • Visiting her husband's grave every week

While grief after loss is normal, it is not normal for a patient to struggle with ADLs such as bathing, grooming, and cleaning her home. In addition, if she has been losing weight, she may not be eating enough.

Across many cultures, it is normal to grieve, visit a loved one's gravestone, and talk about them fondly. 

20.

Which of the following factors affect body temperature?

Select all that apply.

  • Age

  • Menstrual cycle

  • Pregnancy

  • Stress

  • Illness

  • Height

Normal body temperature ranges from 97.5 to 99.5F (36.4 to 37.5C) in the healthy young adult. Factors that influence a patient's body temperature are time of day, environmental temperature, age and sex, physical exercise, menstrual cycle (hormones), pregnancy, stress, illness, and drugs and smoking. All of these factors must be considered when obtaining a patient's temperature. 

Height has little to no effect on body temperature.

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