NCLEX PN Practice Questions | NCLEX PN Quiz

• (A) Give the client pain medication
• (B) Assist the client in dangling his legs
• (C) Have the client breathe deeply
• (D) Provide the client with additional fluids

Check AnswerSolutionBefore walking the client for the first time since surgery, the nurse should ask the client to sit on the side of the bed and dangle his legs, to prevent postural hypotension. Pain medication should not be given before walking; therefore, answer A is incorrect. Answers C and D have no relationship to walking the client; therefore, they are incorrect.

• (A) Recognize that the client’s condition is improving
• (B) Reposition the client and check reflexes again
• (C) Do nothing because the finding is an expected one
• (D) Notify the charge nurse of the finding

Check AnswerSolutionA positive Babinski reflex in adults should be reported to the charge nurse because it indicates an abnormal finding. Answer A is incorrect because a positive Babinski sign in the adult is abnormal, therefore it does not indicate that the client’s condition is improving. Answer B is incorrect because changing the position will not alter the finding. Answer C is incorrect because a positive Babinski reflex is an expected finding in the infant but not in adults.

• (A) With meals or a snack
• (B) 30 minutes before meals
• (C) 30 minutes after meals
• (D) At bedtime

Check AnswerSolutionGantrisin and other sulfa drugs should be given 30 minutes before meals to enhance absorption. Answer A is incorrect because the medication should be given before eating. Answer C is incorrect because the medication should be given on an empty stomach. Answer D is incorrect because the medication is to be given in divided doses throughout the day.

• (A) Decreased pulse rate
• (B) Increased blood pressure
• (C) Decreased respiratory rate
• (D) Increased temperature

Check AnswerSolutionThe client in pain usually has an increased blood pressure. Answers A and C are incorrect because the client in pain will have an increase in the pulse rate and respirations. Temperature is not affected by pain; therefore, answer D is incorrect.

• (A) Brushing the family dog
• (B) Playing with a pet turtle
• (C) Taking a pony ride
• (D) Feeding the family cat

Check AnswerSolutionSalmonella infection is commonly associated with turtles. Answers A, C, and D are incorrect because they are not sources of salmonella infection

• (A) The urine will have a strong odor of ammonia.
• (B) The urinary output will increase in amount.
• (C) The urine will have a red-orange color.
• (D) The urinary output will decrease in amount.

Check AnswerSolutionThe medication will cause the urine to become red-orange in color. Answers A, B, and D are not associated with the use of Pyridium; therefore, they are incorrec

• (A) Keeping the infant warm
• (B) Trimming the fingernails
• (C) Using soap for bathing
• (D) Applying peroxide to dry areas

Check AnswerSolutionThe infant’s fingernails should be kept short to prevent scratching the skin. Keeping the infant warm will increase itching; therefore, answer A is incorrect. Soap should not be used because it dries the skin; therefore, answer C is incorrect. Peroxide is damaging to the tissues; therefore, answer D is incorrect. Practice Exam 4 and Rationales 259

• (A) The infant is diapered or bathed
• (B) The infant raises his arms
• (C) The infant has finished a bottle
• (D) The infant tries to sit

Check AnswerSolutionA Wilms tumor is found by most parents when the infant is being diapered or bathed. Answers B, C, and D are not associated with a Wilms tumor; therefore, they are incorrect.

• (A) The client complains of chest pain and feelings of apprehension
• (B) Ecchymosis is noted on the side of the injured leg
• (C) The client’s oral temperature of 99.2°F
• (D) The client complains of Level 2 pain on a scale of

Check AnswerSolutionComplaints of chest pain and feelings of apprehension are associated with pulmonary emboli, which can occur after the fracture of long bones. These findings should be reported immediately so that interventions can begin. Answer B is incorrect because ecchymosis is common following fractures. Answer C is incorrect because a low-grade temperature is expected because of the inflammatory response. Answer D is incorrect because Level 2 pain is expected in the client with a recent fracture

• (A) Take the medication administration record (MAR) to the room and compare it with the name and medical number recorded on the armband
• (B) Compare the medication administration record (MAR) with the client’s room number and name on the armband
• (C) Request that a family member identify the client, and then ask the client to state his name
• (D) Ask the client to state his full name and then to write his full name

Check AnswerSolutionJCAHO guidelines state that at least two client identifiers should be used whenever administering medications or blood products, whenever samples or specimens are taken, and when providing treatments. Neither of the identifiers is to be the client’s room number. Answer B is incorrect because the client’s room number is not used as an identifier. Answer C and D are incorrect because the best identifiers according to JCAHO are the client’s armband, medical record number, and/or date of birth

• (A) Start cardiac compression
• (B) Give two slow deep breaths
• (C) Open the airway using the head-tilt chin-lift maneuver
• (D) Call for help

Check AnswerSolutionAccording to the American Heart Association, the nurse should call for help before instituting CPR. Answer A is incorrect because the nurse would first call for help. The nurse would not start cardiac compressions before evaluating the client’s carotid pulse. Answer B is incorrect because the nurse would first call for help. The nurse would not administer rescue breathing until she established that the client was not breathing on her own. Answer C is incorrect because the nurse would open the airway after calling for help.

• (A) Until the infection clears
• (B) For 6 months to a year
• (C) Until the cultures are normal
• (D) For the remainder of life

Check AnswerSolutionThe medication must be taken for the remainder of the client’s life to prevent the reoccurrence of CMV infection. Answers A, B, and C are inaccurate statements; therefore, they are incorrect.

• (A) Sun exposure
• (B) Smoking
• (C) Ingesting alcohol
• (D) Ingesting food preservatives

Check AnswerSolutionBasal cell epithelioma, skin cancer, is related to sun exposure. Answers B, C, and D are incorrect because they are not associated with the development of basal cell epithelioma.

• (A) Document the finding and continue to monitor the client
• (B) Irrigate the drainage tube with 10mL of normal saline
• (C) Decrease the amount of intermittent suction
• (D) Notify the RN regarding changes in the drainage

Check AnswerSolutionThe appearance of increased drainage that is clear, colorless, or bile tinged indicates disruption or leakage at one of the anastamosis sites, which requires immediate attention. Answer A is incorrect because the client’s condition will worsen without prompt intervention. Answers B and C are incorrect choices because they cannot be performed without a physician’s order

• (A) Herbals can interfere with the action of antiviral medication.
• (B) Supplements have proven effective in prolonging life.
• (C) Herbals have been shown to decrease the viral load.
• (D) Supplements appear to prevent replication of the virus.

Check AnswerSolutionHerbals such as Echinacea can interfere with the action of antiviral medications; therefore, the client should discuss the use of herbals with his physician. Answer B is incorrect because supplements have not been shown to prolong life.Answer C is incorrect because herbals have not been shown to be effective in decreasing the viral load. Answer D is incorrect because supplements do not prevent replication of the virus.

• (A) Providing cool, noncarbonated beverages
• (B) Instilling eyedrops
• (C) Administering prescribed antiemetics
• (D) Providing small, frequent meals

Check AnswerSolutionThe client with Sjogren’s syndrome complains of dryness of the eyes. The nurse can help relieve the client’s discomfort by instilling eyedrops. Answers A, B, and C do not relieve the symptoms of Sjogren’s syndrome; therefore, they are incorrect. 260 Chapter 4

• (A) Vomiting shortly after eating
• (B) Epigastric pain following meals
• (C) Frequent bouts of diarrhea
• (D) Presence of blood in the stools

Check AnswerSolutionMelena, or blood in the stool, is common in the client with duodenal ulcers. Answers A and B are symptoms of gastric ulcers; therefore, they are incorrect. Diarrhea is not a symptom of duodenal ulcers; therefore, answer C is incorrect.

• (A) Increased weight
• (B) A sore throat
• (C) Difficulty in sleeping
• (D) Changes in mood

Check AnswerSolutionClients who use steroid medications, such as fluticasone, can develop adverse side effects, including oral infections with candida albicans.Symptoms of candida albicans include sore throat and white patches on the oral mucosa. Increased weight, difficulty in sleeping, and changes in mood are expected side effects; therefore, answers A, C, and D are incorrect.

• (A) Concurrent use of two SSRIs
• (B) Eating foods that are high in tyramine
• (C) Drastic decrease in dopamine levels
• (D) Use of medications containing pseudoephedrine

Check AnswerSolutionConcurrent use of two SSRIs can result in serotonin syndrome, a potentially lethal condition. Answer B is incorrect because it refers to the “Parnatecheese” reaction or hypertension that results when the client taking an MAO inhibitor ingests sources of tyramine. Answer C in incorrect because it refers to neuroleptic malignant syndrome or elevations in temperature caused by antipsychotic medication. Answer D is incorrect because it refers to the hypertension that results when MAO inhibitors are used with cold and hayfever medications containing pseudoephedrine.

• (A) Complaints of feeling tired and listless
• (B) Waxy, pale skin
• (C) Loss of coordination and position sense
• (D) Rapid pulse rate and heart murmur

Check AnswerSolutionPernicious anemia is characterized by changes in neurological function such as loss of coordination and loss of position sense. Answers A, B, and D are applicable to all types of anemia; therefore, they are incorrect.