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NCLEX-PN National Council Licensure Examination(NCLEX-PN) Questions and Answers

Questions 4

Which of the following is most likely to impact the body image of an infant newly diagnosed with Hemophilia?

Options:

A.

immobility

B.

altered growth and development

C.

hemarthrosis

D.

altered family processes

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Questions 5

Which of the following is an appropriate nursing goal for a client at risk for nutritional problems?

Options:

A.

provide oxygen

B.

promote healthy nutritional practices

C.

treat complications of malnutrition

D.

increase weight

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Questions 6

Which of the following neurological disorders is characterized by writhing, twisting movements of the face and limbs?

Options:

A.

epilepsy

B.

Parkinson’s

C.

muscular sclerosis

D.

Huntington’s chorea

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Questions 7

Which of the following values should the nurse monitor closely while a client is on total parenteral nutrition?

Options:

A.

calcium

B.

magnesium

C.

glucose

D.

cholesterol

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Questions 8

Major competencies for the nurse giving end-oflife care include:

Options:

A.

demonstrating respect and compassion, and applying knowledge and skills in care of the family and the client.

B.

assessing and intervening to support total management of the family and client.

C.

setting goals, expectations, and dynamic changes to care for the client.

D.

keeping all sad news away from the family and client.

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Questions 9

If a client has chronic renal failure, which of the following sexual complications is the client at risk of developing?

Options:

A.

retrograde ejaculation

B.

decreased plasma testosterone

C.

hypertrophy of testicles

D.

state of euphoria

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Questions 10

The best nursing diagnosis for a client with newly diagnosed Diabetes Mellitus is:

Options:

A.

Impaired Skin Integrity.

B.

Knowledge Deficit: New Diabetes Diagnosis.

C.

Alteration in Nutrition: More than Body Requirements.

D.

Fluid Volume Deficit.

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Questions 11

A nurse is teaching a client newly diagnosed with Emphysema about the disease process. Which of the following statements best explains the problems associated with emphysema and could be adapted for use in the nurse’s discussion with the client?

Options:

A.

Hyperactivity of the medium-sized bronchi caused by an inflammatory response leads to wheezing and tightness in the chest.

B.

Larger than normal air spaces and loss of elastic recoil cause air to be trapped in the lung and collapse airways.

C.

Vasodilation, congestion, and mucosal edema cause a chronic cough and sputum production.

D.

Chloride is not being transported properly, producing excess absorption of water and sodium, and thick viscous mucus.

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Questions 12

A client with an ileus is placed on intestinal tube suction. Which of the following electrolytes is lost with intestinal suction?

Options:

A.

calcium

B.

magnesium

C.

potassium

D.

sodium chloride

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Questions 13

A nurse is caring for a client with an elevated urine osmolarity. The nurse should assess the client for:

Options:

A.

fluid volume excess.

B.

hyperkalemia.

C.

hypercalcemia.

D.

fluid volume deficit.

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Questions 14

For which condition might a client’s antidiuretic hormone (ADH) level be increased?

Options:

A.

diabetes mellitus

B.

diabetes insipidus

C.

hypothyroidism

D.

hyperthyroidism

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Questions 15

The anemias most often associated with pregnancy are:

Options:

A.

folic acid and iron deficiency.

B.

folic acid deficiency and thalassemia.

C.

iron deficiency and thalassemia.

D.

thalassemia and B12 deficiency.

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Questions 16

The client on Floxin must be alerted to which of the following adverse effects?

Options:

A.

stunting of height in teens and young adults

B.

propensity of anovulatory uterine bleeding

C.

intractable diarrhea

D.

tendon rupture

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Questions 17

Ten-year-old Jackie is admitted to the hospital with a medical diagnosis of Rheumatic Fever. She relates a history of “a sore throat about a month ago.” Bed rest with bathroom privileges is prescribed. Which of the following nursing assessments should be given the highest priority when assessing Jackie’s condition?

Options:

A.

her response to being hospitalized

B.

the presence of a macular rash on her trunk

C.

her cardiac status

D.

the presence of polyarthritis and pain in her joints

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Questions 18

Nonpharmacological pain management involves all of the following except:

Options:

A.

hypnosis alone.

B.

psychological care, including support groups.

C.

physical and psychological modalities.

D.

pain-reducing drugs only.

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Questions 19

Increased cortisol levels might be found in a client with which condition?

Options:

A.

Cushing’s syndrome

B.

Addison’s disease

C.

renal failure

D.

congestive heart failure

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Questions 20

Which type of exercises might be prescribed to strengthen the pelvic floor muscles of a client with urinary incontinence?

Options:

A.

Kegel

B.

resistance

C.

passive

D.

stretching

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Questions 21

An 80-year-old aphasic CVA client had abdominal surgery 2 days ago. Which of the following puts this client at the highest risk for inadequate pain management?

Options:

A.

inability to turn, cough, and breathe deeply

B.

inability to communicate pain

C.

inability to ambulate freely

D.

inability to use a bedside commode

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Questions 22

A safety measure to implement when transferring a client with hemiparesis from a bed to a wheelchair is:

Options:

A.

standing the client and walking him or her to the wheelchair.

B.

moving the wheelchair close to client’s bed and standing and pivoting the client on his unaffected extremity to the wheelchair.

C.

moving the wheelchair close to client’s bed and standing and pivoting the client on his affected extremity to the wheelchair.

D.

having the client stand and push his body to the wheelchair.

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Questions 23

Why must the nurse be careful not to cut through or disrupt any tears, holes, bloodstains, or dirt present on the clothing of a client who has experienced trauma?

Options:

A.

The clothing is the property of another and must be treated with care.

B.

Such care facilitates repair and salvage of the clothing.

C.

The clothing of a trauma victim is potential evidence with legal implications.

D.

Such care decreases trauma to the family members receiving the clothing.

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Questions 24

Nurses caring for clients who have cancer and are taking opioids need to assess for all of the following except:

Options:

A.

tolerance.

B.

constipation.

C.

sedation.

D.

addiction.

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Questions 25

Teaching the client with gonorrhea how to prevent reinfection and further spread is an example of:

Options:

A.

primary prevention.

B.

secondary prevention.

C.

tertiary prevention.

D.

primary health care prevention.

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Questions 26

James returns home from school angry and upset because his teacher gave him a low grade on an assignment. After returning home from school, he kicks the dog. This coping mechanism is known as:

Options:

A.

denial.

B.

suppression.

C.

displacement.

D.

fantasy.

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Questions 27

In teaching clients with Buck’s Traction, the major areas of importance should be:

Options:

A.

nutrition, ROM exercises.

B.

ROM exercises, transportation.

C.

nutrition, elimination, comfort, safety.

D.

elimination, safety, isotonic exercises.

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Questions 28

An example of an extended care facility is a:

Options:

A.

home health agency.

B.

suicide prevention center.

C.

state-owned psychiatric hospital.

D.

nursing facility.

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Questions 29

A woman is in the active phase of labor. An external monitor has been applied, and a fetal heart deceleration of uniform shape is observed, beginning just as the contraction is under way and returning to the baseline at the end of the contraction. Which of the following nursing actions is most appropriate?

Options:

A.

Administer O2.

B.

Turn the client on her left side.

C.

Notify the physician.

D.

No action is necessary.

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Questions 30

The tendency of a drug to combine with its receptor is called:

Options:

A.

potency.

B.

efficacy.

C.

kinetics.

D.

affinity.

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Questions 31

The gag reflex test assesses which cranial nerves?

Options:

A.

IX and X

B.

V and VII

C.

IX and XII

D.

V and X

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Questions 32

Which of the following vaccines are not part of the regular schedule of immunizations for children?

Options:

A.

DTaP

B.

MMR

C.

Hib

D.

hepatitis A

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Questions 33

The nurse suspects an elderly client has been the victim of abuse. The client denies abuse and declines assistance. The nurse’s next action should be to:

Options:

A.

do nothing; the client has the right to refuse treatment.

B.

report the incident to the police.

C.

arrange an appointment with the client’s next of kin.

D.

educate the client about available services.

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Questions 34

A 50 milliliter (ml) bolus of normal saline fluid is ordered by the physician. The physician wants it to infuse in 30 minutes. The nurse should set the pump rate at:

Options:

A.

100 ml per hour for one hour.

B.

60 ml per hour for one-half hour.

C.

120 ml per hour for one hour.

D.

50 ml per hour for one hour.

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Questions 35

Which of the following actions should a nurse take first for a client who has just vomited 300 cc of bright red blood?

Options:

A.

Document the vomiting.

B.

Increase the IV fluids.

C.

Get a complete blood count.

D.

Check the blood pressure.

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Questions 36

The teaching plan for a postpartum client who is about to be discharged should include which of the following instructions?

Options:

A.

“It is normal for your breasts to be tender. You should call the physician if you also have redness and fatigue.”

B.

“Because your baby was delivered vaginally, you might have to urinate more frequently.”

C.

“It is normal to run a low-grade temperature for a few days. If it is higher than 100° F, call your physician.”

D.

“Be sure to call your physician if your vaginal discharge becomes bright red.”

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Questions 37

Which of the following diseases places a client at risk for developing cirrhosis?

Options:

A.

type I diabetes

B.

alcoholism

C.

leukemia

D.

glaucoma

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Questions 38

A successful resolution of the nursing diagnosis Negative Self-Concept (related to unrealistic selfexpectations) is when the client can:

Options:

A.

report a positive self-concept.

B.

identify negative thoughts.

C.

recognize positive thoughts.

D.

give one positive cue with each negative cue.

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Questions 39

The nurse is using Cognitive-Behavioral methods of pain control and knows that the these methods can be expected to do all the following except:

Options:

A.

completely relieve all pain.

B.

provide benefit by restoring the client’s sense of self-control.

C.

help the client to control symptoms.

D.

help the client actively participate in his or her own care.

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Questions 40

Which of the following medications should be held 24–48 hours prior to an electroencephalogram (EEG)?

Options:

A.

Lasix (furosemide)

B.

Cardizem (diltiazem)

C.

Lanoxin (digoxin)

D.

Dilantin (phenytoin)

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Questions 41

The nurse should make which of the following responses when questioned by a client about the role of leptin in the body?

Options:

A.

It increases food intake in clients, thereby promoting obesity.

B.

It assists in the regulation of steroids.

C.

It increases the total fat mass of people who are obese.

D.

It might decrease the total fat mass in the bodies of people who are obese.

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Questions 42

A physician orders a serum creatinine for a hospitalized client. The nurse should explain to the client and his family that this test:

Options:

A.

is normal if the level is 4.0 to 5.5 mg/dl.

B.

can be elevated with increased protein intake.

C.

is a better indicator of renal function than the BUN.

D.

reflects the fluid volume status of a person.

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Questions 43

When a client who is 25 years of age asks the nurse when she should seek fertility counseling, the best response by the nurse is:

Options:

A.

“Fertility counseling should be sought when you have been unable to conceive after 1 year of unprotected intercourse.”

B.

“Fertility couseling should be sought when you have not been able to conceive after 6–9 months of unprotected intercourse.”

C.

“The average time it takes someone your age to conceive is 51⁄2 months, so if you haven’t conceived by then, we can refer you.”

D.

“We can give you some guidance now on how to increase your chances of conceiving and then refer you if it doesn’t happen within a year.”

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Questions 44

When a client wishes to improve her appearance by removing excess skin from her face and neck, the nurse should provide teaching regarding which of the following procedures?

Options:

A.

dermabrasion

B.

rhinoplasty

C.

blepharoplasty

D.

rhytidectomy

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Questions 45

A female client complains to the nurse at the health department that she has fatigue, shortness of breath, and lightheadedness. Her history reveals no significant medical problems. She states that she is always on a fad diet without any vitamin supplements. Which tests should the nurse expect the client to have first?

Options:

A.

peptic ulcer studies

B.

complete blood count, including hematocrit and hemoglobin

C.

genetic testing

D.

hemoglobin electrophoresis

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Questions 46

How many temporary teeth should the nurse expect to find in a 5-year-old client’s mouth?

Options:

A.

up to 10

B.

up to 15

C.

up to 20

D.

up to 32

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Questions 47

A nurse discharge planner is preparing a client for discharge from an acute care setting. The nurse assesses that skilled home care services are clinically indicated. This assessment is based on all of the following indicators except:

Options:

A.

the client has been admitted to the hospital three times in the last 2 months.

B.

the client has a Foley catheter.

C.

the client’s family is available to care for him 24 hours a day.

D.

the client is ordered to continue IV antibiotics 5 days post discharge.

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Questions 48

A neighbor telephones the nurse to tell her that her child has erythema infectiosum and asks for information. The nurse knows that another name for the disorder is:

Options:

A.

Kawasaki disease.

B.

rheumatic disease.

C.

lupus erythematosus.

D.

fifth disease.

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Questions 49

American families are having difficulty adequately performing their vital health care function. What are the basic reasons for this difficulty?

Options:

A.

structure of the health care system and family structure

B.

psychological factors for men and women seeking health care

C.

conditions being labeleddisabilitiesand seen as too time consuming

D.

health care organizations (HMOs) and disconnected families

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Questions 50

An adolescent female reports being raped at a party where alcohol was served. The client admits to drinking alcohol before being raped by an acquaintance. The nurse should:

Options:

A.

inform the client that because she is underage, she is at fault for attending a party where alcohol was served.

B.

ask the client if anyone witnessed the event because the client was intoxicated and might not remember correctly.

C.

inform the client that it was not her fault, and support the client through the physical examination.

D.

question whether the woman had consensual sex and now just feels guilty.

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Questions 51

The nurse uses prioritization to determine all the following except:

Options:

A.

time allotment for certain tasks.

B.

appropriate interventions.

C.

treatment procedures.

D.

the need for client education.

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Questions 52

The physician’s role in case management includes all of the following except:

Options:

A.

participating in interdisciplinary planning for clients.

B.

serving as the expert for resource utilization.

C.

consulting with the case management team to facilitate timely orders as needed.

D.

contributing to the documentation of a client’s needs for services.

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Questions 53

The power a nurse exerts when he or she works to accomplish goals and effect change in an agency or in policy is considered what type of power?

Options:

A.

political

B.

personal

C.

positional

D.

professional

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Questions 54

Local anesthetics block the conduction of pain impulses to the spinal cord. Their duration of action:

Options:

A.

is always longer than general anesthesia.

B.

is determined by the rate of diffusion and absorption at the site of administration.

C.

is usually short (10 minutes).

D.

varies, depending on the client’s weight.

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Questions 55

A community health nurse is asked to organize a health promotion project that plans to provide glucose screening. This activity is most beneficial within what realm?

Options:

A.

testing that is performed by volunteers at a local department store and is open to the public

B.

at a professional health fair activity available for selected persons who have been screened as being at risk

C.

mass-marketing vouchers for free fingersticks at a local drug store, where the pharmacist makes recommendations on the findings

D.

testing that is performed by a nurse professional, who immediately provides education regarding the findings

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Questions 56

A complication of total parenteral nutrition (TPN) is the development of cholestasis. What is this condition?

Options:

A.

an inflammatory process of the extrahepatic bile ducts

B.

an arrest of the normal flow of bile

C.

an inflammation of the gallbladder

D.

the formation of gallstones

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Questions 57

The role of the incident report in risk management is:

Options:

A.

liability protection.

B.

to provide data for analysis by a risk manager to determine how future problems can be avoided.

C.

to discipline staff for errors.

D.

all of the above.

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Questions 58

How often must physical restraints be released?

Options:

A.

every 2 hours

B.

between 1 and 3 hours

C.

every 30 minutes

D.

at least every 4 hours

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Questions 59

A child comes to the clinic with a skin rash. The maculopapular lesions are distributed around the mouth and have honey-colored drainage. The caregiver states that the rash is getting worse and seems to spread with the child’s scratching. Which of the following advisory comments should be given?

Options:

A.

The history and presentation might indicate chickenpox, a highly contagious disease.

B.

The lesions might indicate a noncontagious infection that does not require isolation.

C.

The history and presentation might indicate an infectious illness called impetigo.

D.

The lesions are not contagious unless others have open wounds or lesions themselves.

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Questions 60

Common problems for supervisors include all of the following except:

Options:

A.

the supervisor facilitates development of staff members.

B.

the supervisor micromanages staff members.

C.

the supervisor wants to control the style in which a staff member correctly performs a task.

D.

the supervisor does not delegate.

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Questions 61

Client self-determination is the primary focus of:

Options:

A.

malpractice insurance.

B.

nursing’s advocacy for clients.

C.

confidentiality.

D.

health care.

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Questions 62

A client is diagnosed with HIV. Which of the following are antiviral drug classes used in the treatment of HIV/AIDS?

Options:

A.

nucleoside reverse transcriptase inhibitors

B.

protease inhibitors

C.

HIV fusion inhibitors

D.

all of the above.

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Questions 63

The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:

Options:

A.

cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA.

B.

have few, if any, side effects.

C.

are used to treat multiple types of cancer.

D.

are cell-cycle-specific agents.

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Questions 64

Ethical and moral issues concerning restraints include all of the following except:

Options:

A.

emotional impact on the client and family.

B.

dignity of the client.

C.

client’s quality of life.

D.

policies and procedures.

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Questions 65

Using clichés in therapeutic communication leads the client toward:

Options:

A.

viewing the nurse as human.

B.

accepting himself as human.

C.

self-disclosing.

D.

feeling discounted.

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Questions 66

Several passengers aboard an airliner suddenly become weak and suffer breathing difficulty. The diagnosis is likely to be:

Options:

A.

outbreak of Asian flu.

B.

Chemical exposure.

C.

bacterial pneumonia.

D.

allergic reaction.

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Questions 67

A client with massive chest and head injuries is admitted to the ICU from the Emergency Department. All of the following are true except:

Options:

A.

B.the physician in charge of the case is the only person allowed to decide whether organ donation can occur.

B.

C.the client’s legally responsible party may make the decision for organ donation for the donor if the client is unable to do so.

C.

D.the organ procurement organization makes the decision regarding which organs to harvest.

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Questions 68

A 65-year-old female client is experiencing postmenopausal bleeding. Which type of physician should this client be encouraged to see?

Options:

A.

a radiologist

B.

a gynecologist

C.

a physiatrist

D.

an oncologist

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Questions 69

A nurse observes a client sitting alone and talking. When asked, the client reports that he is “talking to the voices.” The nurse’s next action should be:

Options:

A.

touching the client to help him return to reality.

B.

leaving the client alone until reality returns.

C.

asking the client to describe what is happening.

D.

telling the client there are no voices.

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Questions 70

A client is given an opiate drug for pain relief following general anesthesia. The client becomes extremely somnolent with respiratory depression. The physician is likely to order the administration of:

Options:

A.

naloxone (Narcan).

B.

labetalol (Normodyne).

C.

neostigmine (Prostigmin).

D.

thiothixene (Navane).

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Questions 71

In an emergency situation, the nurse determines whether a client has an airway obstruction. Which of the following does the nurse assess?

Options:

A.

ability to speak

B.

ability to hear

C.

oxygen saturation

D.

adventitious breath sounds

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Questions 72

The most effective nursing strategy to assist a client in recognizing and using personal strength includes:

Options:

A.

encouraging the client’s self-identification of strengths.

B.

promoting the client’s active external thinking.

C.

listening to the client and providing advice as needed.

D.

assisting the client in maintaining an external locus of control.

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Questions 73

Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is an advantage of using CVADs for chemotherapeutic agent administration?

Options:

A.

CVADs are less expensive than a peripheral IV.

B.

Weekly administration is possible.

C.

Chemotherapeutic agents can be caustic to smaller veins.

D.

The client or family can administer the drug at home.

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Questions 74

The drug of choice to decrease uric acid levels is:

Options:

A.

prednisone (Colisone).

B.

allopurinol (Zyloprim).

C.

indomethacin (Indocin).

D.

hydrochlorothiazide (HydroDiuril).

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Questions 75

Which of the following is a predisposing factor for cancer of the tongue?

Options:

A.

tobacco use

B.

obesity

C.

sun exposure

D.

eating sweets

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Questions 76

A client receiving drug therapy with furosemide and digitalis requires careful observation and care. In planning care for this client, the nurse should recognize that which of the following electrolyte imbalances is most likely to occur?

Options:

A.

hyperkalemia

B.

hypernatremia

C.

hypokalemia

D.

hypomagnesemia

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Questions 77

The nurse is transferring a client from a wheelchair to the bed. Which is the correct procedure?

Options:

A.

Pull the client toward you, and pivot him on the unaffected limb.

B.

Pull the client toward you, and pivot him on the affected limb.

C.

Push the client toward the bed, and pivot him on the affected limb.

D.

Stand the client on both legs, and push him toward the bed.

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Questions 78

Distraction therapy is:

Options:

A.

focusing one’s attention on stimuli other than pain.

B.

cognitive reappraisal.

C.

the replacement of positive images of pain with other images.

D.

the use of medication and meditation.

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Questions 79

Incidences of child abuse apperar to be higher in the African-American community and might be explained by:

Options:

A.

the increased number of African Americans viewing violence on television.

B.

more single-parent households in African- American communities.

C.

stricter child-rearing practices in African- American households.

D.

a higher occurrence of rage in African Americans.

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Questions 80

Which of the following foods present a problem for a client diagnosed with Celiac Disease?

Options:

A.

butter

B.

oats or barley cereal

C.

fresh vegetables

D.

coffee or tea

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Questions 81

To ensure proper immobilization and increase client comfort when using a rigid splint:

Options:

A.

place the client on a stretcher before splinting.

B.

place the client on a long spine board before splinting.

C.

pad the spaces between the body part and the splint.

D.

ensure that the splint conforms to the body curves.

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Questions 82

In managing nausea related to Morphine epidural analgesia, the nurse should administer:

Options:

A.

Indocin

B.

Codeine

C.

Motrin

D.

Compazine

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Questions 83

When caring for a client with a possible diagnosis of placenta previa, which of the following admission procedures should the nurse omit?

Options:

A.

perineal shave

B.

enema

C.

urine specimen collection

D.

blood specimen collection

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Questions 84

A client with a nasogastric (NG) tube begins vomiting. What action should the nurse take?

Options:

A.

Retape the NG tube.

B.

Clamp the NG tube.

C.

Remove the NG tube.

D.

Check the NG tube placement.

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Questions 85

The test used to differentiate sickle cell trait from sickle cell disease is:

Options:

A.

sickle cell preparation.

B.

peripheral smear.

C.

sickledex.

D.

hemoglobin electrophoresis.

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Questions 86

A hospital discharge planning nurse is making arrangements for a client who has an epidural catheter for continuous infusion of opioids to be placed in a long-term care facility. The family prefers a facility in its neighborhood to facilitate visiting. The neighborhood facility has never cared for a client with this type of need. What is the most appropriate action by the discharge planning nurse?

Options:

A.

B.Arrange for immediate in-services for the long-term care facility staff on pain management using epidural catheters.

B.

C.Explain the situation to the client and family and seek another long-term care facility for discharge from the hospital.

C.

D.Encourage the family to hire private duty nurses skilled in epidural catheter pain management to allow the client to be transferred to the neighborhood facility.

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Questions 87

Which of the following procedures describes an opening between the colon and abdominal wall?

Options:

A.

ileostomy

B.

jejunostomy

C.

colostomy

D.

cecostomy

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Questions 88

Which of the following client groups should the nurse recognize as the fastest-growing segment of the homeless population?

Options:

A.

single, adult men

B.

single mothers with 2 or 3 children

C.

runaway adolescents

D.

single, adult women

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Questions 89

The nurse is caring for a postpartum woman who has relinquished her baby for adoption. The care plan for the client should include which of the following priority strategies?

Options:

A.

Make a referral for grief counseling.

B.

Allow the woman to see her baby initially, and then discourage further visits.

C.

Provide opportunities for the woman to express her feelings.

D.

Inform the woman she has the right to change her mind about relinquishment.

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Questions 90

A client with jaundice has which skin color?

Options:

A.

pale

B.

ruddy

C.

yellow

D.

pink

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Questions 91

A client had a colostomy done one day ago. Which of the following is an abnormal finding when assessing the stoma?

Options:

A.

mild edema

B.

minimal bleeding

C.

rose color

D.

dark red color

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Questions 92

The best lab test to diagnose disseminated intravascular coagulation (DIC) is:

Options:

A.

platelet count.

B.

protime (PT).

C.

partial thromboplastin time (PTT).

D.

D-dimer.

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Questions 93

Issues addressed in ethics committees include all of the following except:

Options:

A.

nonpayment of bills.

B.

euthanasia.

C.

starting or stopping treatment.

D.

use of feeding tubes.

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Questions 94

A patient has just been prescribed Minipress to control hypertension. The nurse should instruct the patient to be observant of the following:

Options:

A.

Dizziness and light headed sensations

B.

Weight gain

C.

Sensory changes in the lower extremities

D.

Fatigue

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Questions 95

A nurse working a surgical unit, notices a patient is experiencing SOB, calf pain, and warmth over the posterior calf. All of these may indicate which of the following medical conditions?

Options:

A.

Patient may have a DVT.

B.

Patient may be exhibiting signs of dermatitis.

C.

Patient may be in the late phases of CHF.

D.

Patient may be experiencing anxiety after surgery.

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Questions 96

A nurse has been ordered to set-up Buck’s traction on a patient’s lower extremity due to a femur fracture. Which of the following applies to Buck’s traction?

Options:

A.

A weight greater than 10 lbs. should be used.

B.

The line of pull is upward at an angle.

C.

The line of pull is straight

D.

A weight greater than 20 lbs. should be used.

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Questions 97

A high school nurse observes a 14 year-old female rubbing her scalp excessively in the gym. The most appropriate course of action for the nurse to do is:

Options:

A.

Request a private evaluation of the female’s scalp from her parents.

B.

Contact the female’s parents about the observations.

C.

Observe the hairline and scalp for possible signs of lice.

D.

Contact the student’s physician.

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Questions 98

A patient has suffered a left CVA and has developed severe hemiparesis resulting in a loss of mobility. The nurse notices on assessment that an area over the patient’s left elbow appears as non-blanchable erythema and the skin is intact. The nurse should score the patient as having which of the following?

Options:

A.

Stage I pressure ulcer

B.

Stage II pressure ulcer

C.

Stage III pressure ulcer

D.

Stage IV pressure ulcer

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Questions 99

A patient has been diagnosed with diabetes mellitus. Which of the following is not a clinical sign of diabetes mellitus?

Options:

A.

Polyphagia

B.

Polyuria

C.

Metabolic acidosis

D.

Lower extremity edema

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Questions 100

A nurse is caring for a retired MD. The MD asks the question, “What type of cells create exocrine secretions?” The correct answer is:

Options:

A.

alpha cells

B.

beta cells

C.

acinar cells

D.

plasma cells

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Questions 101

A client is 36 hours post-op a TKR surgery. 270 cc’s of sero-sanguinous accumulates in the surgical drains. What action should the nurse take?

Options:

A.

Notify the doctor

B.

Empty the drain

C.

Do nothing

D.

Remove the drain

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Questions 102

Which of the following is not considered one of the main mechanisms of Type II Diabetes treatment?

Options:

A.

Medications

B.

Nutrition

C.

Increased activity

D.

Continuous Insulin

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Questions 103

Following a classic cholecystectomy resection for multiple stones, the PACU nurse observes a serosanguious drainage on the dressing. The most appropriate intervention is to:

Options:

A.

notify the physician of the drainage.

B.

change the dressing.

C.

reinforce the dressing.

D.

apply an abdominal binder.

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Questions 104

Which of the following nursing actions is most effective when evaluating a kinetic family drawing?

Options:

A.

telling the child to draw their family doing something

B.

offering specific suggestions of what to include in the drawing

C.

discouraging the child from talking about the drawing

D.

noting the omission of any family members

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Questions 105

Which of the following is the primary force in sex education in a child’s life?

Options:

A.

school nurse

B.

peers

C.

parents

D.

media

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Questions 106

A batterer is usually someone who:

Options:

A.

grew up in a loving, secure home.

B.

was an only child.

C.

was physically or psychologically abused.

D.

admits he has a problem with anger.

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Questions 107

A health care worker is concerned about a new mother being overwhelmed by caring for her infant. The health care worker should:

Options:

A.

immediately contact child protective services.

B.

provide the mother with literature about child care.

C.

consult a therapist to help the mother work out her fears.

D.

refer the mother to parenting classes.

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Questions 108

A client has been taking alprazolam (Xanax) for four years to manage anxiety. The client reports taking 0.5 mg four times a day. Which statement indicates that the client understands the nurse’s teaching about discontinuing the medication?

Options:

A.

“I can drink alcohol now that I am decreasing my Xanax.”

B.

“I should not take another Xanax pill. Here is what is left of my last prescription.”

C.

“I should take three pills per day next week, then two pills for one week, then one pill for one week.”

D.

“I can expect to be sleepy for several days after stopping the medicine.”

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Exam Code: NCLEX-PN
Exam Name: National Council Licensure Examination(NCLEX-PN)
Last Update: Nov 16, 2024
Questions: 725

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