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Quiz Session - Attempts With Random Questions

NCLEX-RN Exam Questions

Page 3 of 65

41.

You have been assigned a nursing student for the shift, and they wish to assist with a medication pass. Which of the following would you ensure they complete before the medication is given?

Select all that apply.

  • Ensure you have the right patient

  • Ensure you have the right drug 

  • Ensure you have the right med-pass time

  • Ensure the medication is the correct dose 

  • Ensure the medication is administered by the correct route 

  • Ensure a family member at the bedside can verify home medications

  • Ensure all medications are pre-popped before entering the room

Most healthcare professionals, especially nurses, must follow the “five rights” of medication use: the right patient, the right drug, the right time, the right dose, and the right route.

42.

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 as 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.

43.

The nurse received an order to administer intravenous (IV) phenytoin (Dilantin) for seizure control. In administering this medication via IV route, the nurse knows to give slowly to prevent which of the following from occurring? 

Select all that apply.

  • Hypotension

  • Cardiac dysrhythmias

  • Severe nausea and vomiting 

  • Hypoglycemia

  • Severe headache 

Phenytoin is a common antiseizure medication used to prevent and control seizures. This drug must be given slowly to prevent hypotension and cardiac dysrhythmias. It should always be diluted in normal saline (dextrose causes the medication to precipitate), infused with an inline filter, and given no faster than 25 to 50 mg/minute. In addition, it may decrease the effectiveness of some birth control pills and may cause teratogenic effects if taken during pregnancy. 

It is not likely to cause severe nausea and vomiting, hypoglycemia, or headache if administered too quickly.

44.

A 21-year-old college student has been taking lorazepam (Ativan) 0.5 mg orally as needed at bedtime to treat her insomnia caused by anxiety. What is the most commonly reported side effect of lorazepam (Ativan) the student is likely to experience?

  • Sedation

  • Dizziness

  • Headache

  • Dry mouth

Correct answer: Sedation

Approximately 16% of patients who are prescribed lorazepam (Ativan) to treat anxiety experience sedation, making it the most commonly reported side effect. Other less commonly reported side effects include:

  • dizziness
  • drowsiness
  • orthostatic hypotension
  • blurred vision
  • weakness
  • headache
  • disorientation
  • constipation
  • dry mouth
  • rash
  • dermatitis
  • acidosis

45.

Infusion time for any blood component should not exceed:

  • 4 hours

  • 1 hour

  • 2 hours

  • 6 hours

Correct answer: 4 hours

Blood components should be infused within 4 hours. If blood is received and cannot be infused within this time frame, it should be returned to the blood bank for proper disposal.

46.

You are concerned that your patient, who is post-op from an abdominal hysterectomy, is developing an infection. Which of the following signs/symptoms could indicate infection?

  • White blood cell count of 13,800/µl

  • Tympanic temperature of 99.0 degrees Fahrenheit

  • Complaint of abdominal pain

  • Clear yellow urine in the catheter drainage bag

Correct answer: White blood cell count of 13,800/µl

A WBC count of 13,800 µl is higher than normal, indicating a possible infection (although an elevated WBC count does not indicate where the infection is).

Clear yellow urine is normal, as is a temperature of 99.0 degrees Fahrenheit measured tympanically. Abdominal pain should be expected following an abdominal hysterectomy.

47.

The most common complication of hemodialysis is:

  • Hypotension

  • Abdominal pain

  • Disequilibrium syndrome

  • Chest pain

Correct answer: Hypotension

Hypotension occurs most frequently, affecting 20 to 30% of patients at some point. It may be caused by removing too much weight (i.e. due to inaccurate pre-dialysis weight), heart disease, septicemia, or taking blood pressure medications prior to dialysis.

48.

Immediately after an amniotomy has been performed, the nurse should first assess which of the following?

  • The fetal heart rate pattern

  • Bladder distension

  • Cervical dilation

  • The maternal blood pressure

Correct answer: The fetal heart rate pattern

The FHR is assessed immediately after amniotomy to detect any changes that may indicate cord compression or prolapse. Bladder distension or maternal blood pressure would not be the first thing to check after the amniotomy.

49.

A patient suspected of having primary hypothyroidism would exhibit which of the following laboratory results?

Select all that apply.

  • Decreased FT4 (free thyroxine) levels  

  • Elevated TSH (thyroid-stimulating hormone) levels 

  • Decreased T3 (triiodothyronine) levels 

  • Elevated total T4 (thyroxine) levels

  • Elevated T3 resin uptake

To diagnose thyroid disorders, the following blood tests are used:

  • T3 and T4 resin uptake test (T3 and T4 regulate thyroid-stimulating hormone)
  1. total triiodothyronine T3
  2. total thyroxine T4
  3. free thyroxine (FT4)
  • Thyroid-stimulating hormone (TSH)

In primary hypothyroidism, the laboratory values are as follows:

  • T4 levels are decreased (both total and free)
  • T3 levels are decreased
  • TSH levels are increased

50.

In which of the following conditions is breastfeeding contraindicated? 

Select all that apply.

  • The mother who is HIV (human immunodeficiency virus) positive

  • The mother with active, untreated tuberculosis

  • The mother who has a history of breast surgery

  • The mother who has hepatitis B virus (HBV)

  • The mother who has mastitis 

An HIV-positive mother should not breastfeed, as the virus could be passed to the infant through the mother's breast milk. In addition, the mother with active, untreated tuberculosis should also not breastfeed, for the same reason (only promote breastfeeding if the patient is noninfectious). 

Breast surgery could cause a low milk supply, but that should not hinder the mother from trying to breastfeed. Frequent feedings will maintain milk supply, and if the baby does not seem to be getting enough (weight gain or output is not adequate), the mother can then choose to supplement. The mother with mastitis should be encouraged to feed baby directly at the breast or pump (if too painful to latch directly) and feed the baby expressed breastmilk. There is no contraindication to breastfeeding with mastitis. The mother with HBV should initiate breastfeeding after the infant receives the first of a 3-dose immunization series of Hepatitis B.

51.

A nurse is working with a patient who has heart disease. The patient's height is 5'10" and his weight is 220 pounds. The nurse informs the patient that he should try to keep his body mass index (BMI) between 19 and 25. What is the patient's current BMI?

  • 31.6

  • 23.1

  • 16.6

  • 41.8

Correct answer: 31.6

The patient's current BMI is 31.6. In order to calculate the BMI, you will need to convert the patient's weight from pounds to kilograms, and his height to squared centimeters.

  • 220 pounds x 0.453592 (the metric conversion factor) = 99.79024 kg
  • 70 inches x 0.0254 (the metric conversion factor) = 1.778 m
  • Square the height: 1.778 x 1.778 = 3.161284
  • Divide the converted weight by the squared height: 99.79024/3.161284 = 31.6

The BMI for a patient who is 5'10" and 220 pounds is 31.6.

52.

A patient is taking Alprazolam (Xanax) 0.25 mg three times a day. The patient's physician increased the dose to 0.5 mg three times a day. The nurse only has 0.25 mg tablets available for this patient. How many tablets should the nurse give this patient?

  • Two 0.25 mg tablets, three times a day

  • One-half of a 0.25 mg tablet, three times a day

  • Three 0.25 mg tablets, three times a day

  • One and one-half 0.25 mg tablets, three times a day

Correct answer: Two 0.25 mg tablets, three times a day

The nurse should give this patient two 0.25 mg tablets, three times a day. By giving the patient two 0.25 mg tablets, the nurse is providing the patient with 0.5 mg (0.25 mg x 2 tablets = 0.5 mg).

One-half of a 0.25 tablet would only be 0.125 mg, which is not what the physician ordered. Three 0.25 mg tablets would be 0.75 mg, which is not what the physician ordered. One and one-half of 0.25 mg tablets would be 0.375 mg, which is not what the physician ordered.

53.

The nurse is preparing to obtain vital signs on a patient. When taking the patient's blood pressure (BP), which of the following statements is/are accurate? 

Select all that apply.

  • Using a cuff that is too small will result in a falsely high reading

  • Using a cuff that is too large will result in a falsely low reading

  • Blood pressure trends upward as the patient ages

  • Opioid analgesics often raise blood pressure readings

  • Blood pressure is generally the lowest in the evening

Choosing the right size cuff for the patient is essential in obtaining an accurate BP reading; one that is too small may yield a falsely high reading, and one that is too large could cause the reading to be falsely low. If the nurse suspects an error in the BP result, always obtain a second BP measurement (using the opposite arm if possible). As the patient ages, BP tends to increase, and it is best to check a BP in the early morning as that is when it is typically the lowest. As the day progresses, the BP trends upward, peaking in the late afternoon and evening. Opioid analgesics and antihypertensive medications can decrease BP. A normal BP reading for an adult is a systolic pressure below 120 mm Hg and a diastolic pressure below 80 mm Hg.

54.

Patients who are taking thiazides should include in their diet foods that are high in:

  • Potassium

  • Sodium

  • Calcium

  • Phosphorus

Correct answer: Potassium

Thiazide diuretics deplete potassium. The patient should be counseled to add foods such as squash, baked potatoes, pears, peaches, oranges, and bananas to their diet.

55.

Your 8-year-old patient has tonsillitis. The physician prescribes Amoxicillin 20 mg/kg po daily in 3 divided doses. Your patient weighs 71 pounds. How much medication will a single dose contain (in mg)? Round to the nearest whole number.

  • 213 mg

  • 757 mg

  • 640 mg

  • 160 mg

Correct answer: 213 mg

71 lbs = 32 kg

20 mg × 32 kg = 640 mg

640 mg ÷ 3 = 213.33

Each dose of Amoxicillin will equal 213 mg.

56.

You receive an order to administer oxytocin (Pitocin) 2 milliunits (mU) per minute. The pharmacy sends up the oxytocin (Pitocin) as 20 units (U) in 1,000 mL of 5% dextrose in water (D5W).

Calculate how many mL per hour the patient needs to receive in order to receive the prescribed dose of oxytocin (Pitocin).

  • 6 mL/hour

  • 0.1 mL/hr

  • 1 mL/hr

  • 0.6 mL/hour

Correct answer: 6 mL/hour

In this scenario, you will need to perform several calculations to arrive at the correct answer. You will need to remember to convert from milliunits (mU) to units (U), as the medication sent from the pharmacy has been dosed in units.

Calculate the number of units per 2 milliunits

Knowing that there are 1,000 milliunits (mU) in 1 unit (U), you can write the following equation to determine how many units are in 2 milliunits.

Let x represent the unknown.

1,000 mU: 1U = 2 mU:xU

We then get 1000x = 2, which we divide to get the answer, there are 0.002 units in 2 milliunits.

Calculate how many mL per minute

Next, using the standard formula of Prescribed / Available × Volume, we plug-in our numbers and solve the following equation:

0.002U / 20U × 1,000 mL = 0.1 mL

The patient should receive 0.1 mL/minute.

Calculate how many mL per hour

The final step is to determine how many mL should be given in one hour, as this is what the question asked you to calculate. Having determined that the patient should receive 0.1 mL/minute, we can write the following equation to obtain our final answer:

0.1 mL/minute × 60 minutes/hour = 6 mL/hour

The patient should receive 6 mL of the oxytocin (Pitocin) solution per hour to receive the prescribed dose.

57.

A child is suspected of having rheumatic fever. Which of the following laboratory test results would assist in confirming this diagnosis? 

Select all that apply.

  • Elevated antistreptolysin O titer 

  • Elevated erythrocyte sedimentation rate (ESR)

  • Elevated C-reactive protein (CRP)

  • Aschoff bodies

  • Elevated red blood cell count 

Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central nervous system. The most serious complication is rheumatic heart disease. It is often associated with a previous group A beta-hemolytic streptococcal infection (strep throat) that was either left untreated or partially treated. 

The following laboratory results will aid in confirming the diagnosis: 

  • presence of elevated antistreptolysin O titer
  • elevated ESR
  • elevated CRP
  • aschoff bodies (lesions found in the heart, blood vessels, brain, and serous surfaces of the joints and pleura)

58.

You are working for a telehealth phone line. A mother calls and is worried that her children may have a vector after coming home from summer camp. 

Which of the following are examples of Vectors? 

Select all that apply.

  • Mosquito bites

  • Ticks

  • Fleas

  • Poison ivy 

  • Sun dermatitis 

  • Snake bite

A vector is a living organism that transmits an infectious agent. Examples would be a tick spreading lime disease or fleas on rats that caused the bubonic plague. 

A vector must be transmitting an infectious disease. Poison ivy and sun dermatitis are forms of isolated irritation that do not spread. A snake bite is from another living organism, but it is not an infectious disease. 

59.

Carlos, who speaks only Spanish, is scheduled for a same-day surgery. Which of the following would be appropriate for getting his informed consent? 

Select all that apply.

  • Have a translator give the patient their informed consent paperwork and explain the procedure. 

  • Speak loudly when explaining the procedure and gesture for him to sign. 

  • Have the patient's family members interpret his informed consent. 

The only way to ensure that the patient is getting the correct information is to have a hospital staff interpreter explain the procedure and go over the informed consent form. 

The patient's family member is not able to explain the procedure or the risks and benefits with the appropriate level of knowledge. It is your responsibility to go over the procedure, risks and benefits, alternative procedures, and the ramifications of refusal. 

60.

Your 42-year-old female patient is undergoing a core needle biopsy of her breast. You are providing aftercare instructions. Which of the following should the patient be instructed to report to her physician immediately?

  • Sudden difficulty breathing

  • Tenderness at the needle insertion site

  • Bruising of the breast around the site of the biopsy

  • Discomfort while wearing a bra

Correct answer: Sudden difficulty breathing

Sudden difficulty breathing may signify a pneumothorax, a rare complication that could potentially be life-threatening. Other symptoms that should be reported immediately include:

  • Altered color
  • Sensation or movement of the arm or hand on the affected side
  • Signs/symptoms of infection (redness, swelling, pus or drainage) from the needle insertion site
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