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NCLEX- RN Practice Exam 5 (PM)
Text Mode– Text version of the exam.
- Increased urinary output.
- Decreased edema.
- Decreased pain.
- Decreased blood pressure.
2. There are a number of risk factors associated with coronary artery disease. Which of the following is a modifiable risk factor?
3. Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA?
- Worsening chest pain that began earlier in the evening.
- History of cerebral hemorrhage.
- History of prior myocardial infarction.
4. Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient?
- Increases fitness and prevents future heart attacks.
- Prevents bedsores.
- Prevents DVT (deep vein thrombosis).
- Prevent constipations.
5. A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock?
- Bounding pulse.
6. A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform?
- Ask the patient to lie down on the exam table.
- Draw blood for chemistry panel and arterial blood gas (ABG).
- Send the patient for a chest x-ray.
- Check blood pressure.
7. A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse complaining of frequent headaches. Which of the following responses to the patient is correct?
- “Stop taking the nitroglycerin and see if the headaches improve.”
- “Go to the emergency department to be checked because nitroglycerin can cause bleeding in the brain.”
- “Headaches are a frequent side effect of nitroglycerine because it causes vasodilation.”
- “The headaches are unlikely to be related to the nitroglycerin, so you should see your doctor for further investigation.”
8. A patient received surgery and chemotherapy for colon cancer, completing therapy 3 months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations could account for her symptoms?
- The symptoms may be the result of anemia caused by chemotherapy.
- The patient may be immunosuppressed.
- The patient may be depressed.
- The patient may be dehydrated.
9. A clinic patient has a hemoglobin concentration of 10.8 g/dL and reports sticking to a strict vegetarian diet. Which of the follow nutritional advice is appropriate?
- The diet is providing adequate sources of iron and requires no changes.
- The patient should add meat to her diet; a vegetarian diet is not advised.
- The patient should use iron cookware to prepare foods, such as dark green, leafy vegetables and legumes, which are high in iron.
- A cup of coffee or tea should be added to every meal.
10. A hospitalized patient is receiving packed red blood cells (PRBCs) for treatment of severe anemia. Which of the following is the most accurate statement?
- Transfusion reaction is most likely immediately after the infusion is completed.
- PRBCs are best infused slowly through a 20g. IV catheter.
- PRBCs should be flushed with a 5% dextrose solution.
- A nurse should remain in the room during the first 15 minutes of infusion.
11. A patient who has received chemotherapy for cancer treatment is given an injection of Epoetin. Which of the following should reflect the findings in a complete blood count (CBC) drawn several days later?
- An increase in neutrophil count.
- An increase in hematocrit.
- An increase in platelet count.
- An increase in serum iron.
12. A patient is admitted to the hospital with suspected polycythemia vera. Which of the following symptoms is consistent with the diagnosis?
- Weight loss.
- Increased clotting time.
13. A nurse is caring for a patient with a platelet count of 20,000/microliter. Which of the following is an important intervention?
- Observe for evidence of spontaneous bleeding.
- Limit visitors to family only.
- Give aspirin in case of headaches.
- Impose immune precautions.
14. A nurse in the emergency department assesses a patient who has been taking long-term corticosteroids to treat renal disease. Which of the following is a typical side effect of corticosteroid treatment? Note: More than one answer may be correct.
- Cushingoid features.
- Low serum albumin.
15. A nurse is caring for patients in the oncology unit. Which of the following is the most important nursing action when caring for a neutropenic patient?
- Change the disposable mask immediately after use.
- Change gloves immediately after use.
- Minimize patient contact.
- Minimize conversation with the patient.
16. A patient is undergoing the induction stage of treatment for leukemia. The nurse teaches family members about infectious precautions. Which of the following statements by family members indicates that the family needs more education?
- We will bring in books and magazines for entertainment.
- We will bring in personal care items for comfort.
- We will bring in fresh flowers to brighten the room.
- We will bring in family pictures and get well cards.
17. A nurse is caring for a patient with acute lymphoblastic leukemia (ALL). Which of the following is the most likely age range of the patient?
- 3-10 years.
- 25-35 years.
- 45-55 years.
- over 60 years.
18. A patient is admitted to the oncology unit for diagnosis of suspected Hodgkin’s disease. Which of the following symptoms is typical of Hodgkin’s disease?
- Painful cervical lymph nodes.
- Night sweats and fatigue.
- Nausea and vomiting.
- Weight gain.
19. The Hodgkin’s disease patient described in the question above undergoes a lymph node biopsy for definitive diagnosis. If the diagnosis of Hodgkin’s disease were correct, which of the following cells would the pathologist expect to find?
- Reed-Sternberg cells.
- Lymphoblastic cells.
- Gaucher’s cells.
- Rieder’s cells
20. A patient is about to undergo bone marrow aspiration and biopsy and expresses fear and anxiety about the procedure. Which of the following is the most effective nursing response?
- Warn the patient to stay very still because the smallest movement will increase her pain.
- Encourage the family to stay in the room for the procedure.
- Stay with the patient and focus on slow, deep breathing for relaxation.
- Delay the procedure to allow the patient to deal with her feelings.
21. A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and the nurse prepares to implement protective isolation procedures. Which interventions would the nurse initiate? Select all that apply.
- Restrict all visitors.
- Place the child on a low-bacteria diet.
- Change dressings using sterile technique.
- Encourage the consumption of fresh fruits and vegetables.
- Perform meticulous hand washing before caring for the child.
- Allow fresh-cut flowers in the room as long as they are kept in a vase with fresh water.
22. A 16-year-old child is brought to the emergency department by his mother with a complaint that the child just experienced a tonic-clonic seizure. On arrival in the emergency department no apparent seizures were occurring. The mother states that her son is taking medication for the seizure disorder. The nurse plans care, knowing that which of the following medications are used for long-term control of tonic-clonic seizures? Select all that apply.
- Diazepam (Valium)
- Alprazolam (Xanax)
- Gabapentin (Neurontin)
- Ethosuximide (Zarontin)
- Carbamazepine (Tegretol)
- Methylphenidate (Ritalin)
23. A child has been diagnosed with meningococcal meningitis. Which of the following isolation techniques is appropriate?
- Enteric precautions
- Neutropenic precautions
- No precautions are required as long as antibiotics have been started.
- Isolation precautions for at least 24 hours after the initiation of antibiotics
24. A client enters the emergency department confused, twitching, and having seizures. His family states he recently was placed on corticosteroids for arthritis and was feeling better and exercising daily. On data collection, he has flushed skin, dry mucous membranes, an elevated temperature, and poor skin turgor. His serum sodium level is 172 mEq/L. Choose the interventions that the health care provider would likely prescribe. Select all that apply.
- Monitor intake and output.
- Monitor vital signs.
- Maintain sodium-reduced diet.
- Monitor electrolyte levels.
- Increase water intake orally.
- Administer sodium replacements.
25. A client has died, and a nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. The nurse’s appropriate action is to:
- Show acceptance of feelings.
- Provide information needed for decision making.
- Suggest a referral to a mental health professional.
- Remain with the family member without discussing funeral arrangements.
Answers and Rationales
- Answer: C. Furosemide, a loop diuretic, does not alter pain. Furosemide acts on the kidneys to increase urinary output. Fluid may move from the periphery, decreasing edema. Fluid load is reduced, lowering blood pressure.
- Answer: A. Obesity is an important risk factor for coronary artery disease that can be modified by improved diet and weight loss. Family history of coronary artery disease, male gender, and advancing age increase risk but cannot be modified.
- Answer: B. A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension.
- Answer: C. Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase physical fitness, nor is it intended to prevent bedsores or constipation.
- Answer: D. Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.
- Answer: D. A patient with congestive heart failure and dyspnea may have pulmonary edema, which can cause severe hypertension. Therefore, taking the patient’s blood pressure should be the first action. Lying flat on the exam table would likely worsen the dyspnea, and the patient may not tolerate it. Blood draws for chemistry and ABG will be required, but not prior to the blood pressure assessment.
- Answer: C. Nitroglycerin is a potent vasodilator and often produces unwanted effects such as headache, dizziness, and hypotension. Patients should be counseled, and the dose titrated, to minimize these effects. In spite of the side effects, nitroglycerine is effective at reducing myocardial oxygen consumption and increasing blood flow. The patient should not stop the medication. Nitroglycerine does not cause bleeding in the brain.
- Answer: A. Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects, which often includes anemia because of bone-marrow suppression. There is no evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of immunosuppression. The information given does not indicate that depression or dehydration is a cause of her symptoms.
- Answer: C. Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly anemic. When food is prepared in iron cookware its iron content is increased. In addition, dark green leafy vegetables, such as spinach and kale, and legumes are high in iron. Mild anemia does not require that animal sources of iron be added to the diet. Many non-animal sources are available. Coffee and tea increase gastrointestinal activity and inhibit absorption of iron.
- Answer: D. Transfusion reaction is most likely during the first 15 minutes of infusion, and a nurse should be present during this period. PRBCs should be infused through a 19g or larger IV catheter to avoid slow flow, which can cause clotting. PRBCs must be flushed with 0.45% normal saline solution. Other intravenous solutions will hemolyze the cells.
- Answer: B. Epoetin is a form of erythropoietin, which stimulates the production of red blood cells, causing an increase in hematocrit. Epoetin is given to patients who are anemic, often as a result of chemotherapy treatment. Epoetin has no effect on neutrophils, platelets, or serum iron.
- Answer: B, C, and D. Polycythemia vera is a condition in which the bone marrow produces too many red blood cells. This causes an increase in hematocrit and viscosity of the blood. Patients can experience headaches, dizziness, and visual disturbances. Cardiovascular effects include increased blood pressure and delayed clotting time. Weight loss is not a manifestation of polycythemia vera.
- Answer: A. Platelet counts under 30,000/microliter may cause spontaneous petechiae and bruising, particularly in the extremities. When the count falls below 15,000, spontaneous bleeding into the brain and internal organs may occur. Headaches may be a sign and should be watched for. Aspirin disables platelets and should never be used in the presence of thrombocytopenia. Thrombocytopenia does not compromise immunity, and there is no reason to limit visitors as long as any physical trauma is prevented.
- Answer: A, B, and D. Side effects of corticosteroids include weight gain, fluid retention with hypertension, Cushingoid features, a low serum albumin, and suppressed inflammatory response. Patients are encouraged to eat a diet high in protein, vitamins, and minerals and low in sodium. Corticosteroids cause hypernatremia, not hyponatremia.
- Answer: B. The neutropenic patient is at risk of infection. Changing gloves immediately after use protects patients from contamination with organisms picked up on hospital surfaces. This contamination can have serious consequences for an immunocompromised patient. Changing the respiratory mask is desirable, but not nearly as urgent as changing gloves. Minimizing contact and conversation are not necessary and may cause nursing staff to miss changes in the patient’s symptoms or condition.
- Answer: C. During induction chemotherapy, the leukemia patient is severely immunocompromised and at risk of serious infection. Fresh flowers, fruit, and plants can carry microbes and should be avoided. Books, pictures, and other personal items can be cleaned with antimicrobials before being brought into the room to minimize the risk of contamination.
- Answer: A. The peak incidence of ALL is at 4 years (range 3-10). It is uncommon after the mid-teen years. The peak incidence of chronic myelogenous leukemia (CML) is 45-55 years. The peak incidence of acute myelogenous leukemia (AML) occurs at 60 years. Two-thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years.
- Answer: B. Symptoms of Hodgkin’s disease include night sweats, fatigue, weakness, and tachycardia. The disease is characterized by painless, enlarged cervical lymph nodes. Weight loss occurs early in the disease. Nausea and vomiting are not typically symptoms of Hodgkin’s disease.
- Answer: A. A definitive diagnosis of Hodgkin’s disease is made if Reed-Sternberg cells are found on pathologic examination of the excised lymph node. Lymphoblasts are immature cells found in the bone marrow of patients with acute lymphoblastic leukemia. Gaucher’s cells are large storage cells found in patients with Gaucher’s disease. Rieder’s cells are myeloblasts found in patients with acute myelogenous leukemia.
- Answer: C. Slow, deep breathing is the most effective method of reducing anxiety and stress. It reduces the level of carbon dioxide in the brain to increase calm and relaxation. Warning the patient to remain still will likely increase her anxiety. Encouraging family members to stay with the patient may make her worry about their anxiety as well as her own. Delaying the procedure is unlikely to allay her fears.
- Answer: B, C, and E. For the hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas, to which these children are very susceptible. Fruits and vegetables not peeled before being eaten harbor molds and should be avoided until the white blood cell count rises. The child is placed on a low-bacteria diet. Dressings are always changed with sterile technique. Not all visitors need to be restricted, but anyone who is ill should not be allowed in the child’s room. Meticulous hand washing is required before caring for the child. In addition, gloves, a mask, and a gown are worn (per agency policy).
- Answers: C, D, and E. Medications that are prescribed for long-term control of tonic-clonic seizures are gabapentin, ethosuximide, and carbamazepine. Diazepam is a medication that is prescribed to halt tonic-clonic episodes, and methylphenidate is a medication used to treat attention deficit hyperactivity disorder. Both of these medications are not suitable for long-term control of a seizure condition. Alprazolam is a medication used to treat anxiety.
- Answer: D. Meningococcal meningitis is transmitted primarily by droplet infection. Isolation is begun and maintained for at least 24 hours after antibiotics are given. Other options are incorrect.
- Answers: A, B, C, D, and E. Hypernatremia is described as having a serum sodium level that exceeds 145 mEq/L. Signs and symptoms would include dry mucous membranes, loss of skin turgor, thirst, flushed skin, elevated temperature, oliguria, muscle twitching, fatigue, confusion, and seizures. Interventions include monitoring fluid balance, monitoring vital signs, reducing dietary intake of sodium, monitoring electrolyte levels, and increasing oral intake of water. Sodium replacement therapy would not be prescribed for a client with hypernatremia.
- Answer: D. The family member is exhibiting the first stage of grief (denial), and the nurse should remain with the family member.Showing acceptance of feelings is an appropriate intervention for the acceptance or reorganization and restitution stage.Providing information needed for decision making may be an appropriate intervention for the bargaining stage.Suggesting a referral to a mental health professional may be an appropriate intervention for depression.