NCLEX 75 QUESTIONS WITH

NCLEX 75 QUESTIONS WITH

ANSWERS LATEST REVIEW

The nurse is taking the health history of a patient being treated for Emphysema and Chronic Bronchitis. After being told the patient has been smoking cigarettes for 30 years, the nurse expects to note which assessment finding?

• Increase in Forced Vital Capacity (FVC)
• A narrowed chest cavity
• Clubbed fingers
• An increased risk of cardiac failure - ANSWER - - 1.

Increase in Forced Vital Capacity (FVC) Forced Vital Capacity is the volume of air exhaled from full inhalation to full exhalation. A patient with COPD would have a decrease in FVC. Incorrect.

• A narrowed chest cavity

A patient with COPD often presents with a 'barrel chest,' which is seen as a widened chest cavity. Incorrect.

• Clubbed fingers - CORRECT

Clubbed fingers are a sign of a long-term, or chronic, decrease in oxygen levels.

• An increased risk of cardiac failure

Although a patient with these conditions would indeed be at an increased risk for cardiac failure, this is a potential complication and not an assessment finding.Incorrect.The nurse is taking the health history of a 70-year-old patient being treated for a Duodenal Ulcer. After being told the patient is complaining of epigastric pain, the nurse expects to note which assessment finding? 1 / 4

• Melena
• Nausea
• Hernia
• Hyperthermia - ANSWER - - 1. Melena - CORRECT

Melena is the finding that there are traces of blood in the stool which presents as black, tarry feces. This is a common manifestation of Duodenal Ulcers, since the Duodenum is further down the gastric anatomy.

• Nausea

Nausea may be present, but is a generalized symptom and by itself doesn't indicate a Duodenal Ulcer. Incorrect.

• Hernia

A Hernia is a protrusion of a segment of the abdomen through another abdominal structure. It is not associated with an Ulcer and is a condition, not an assessment finding. Incorrect.

• Hyperthermia

Hyperthermia, a high temperature, is not an assessment finding of a Duodenal Ulcer. Incorrect A nurse is providing discharge teaching for a patient with severe Gastroesophogeal Reflux Disease. Which of these statements by the patient indicates a need for more teaching?

• "I'm going to limit my meals to 2-3 per day to reduce acid secretion."
• "I'm going to make sure to remain upright after meals and elevate my head when

I sleep"

• "I won't be drinking tea or coffee or eating chocolate any more."
• "I'm going to start trying to lose some weight." - ANSWER - -
• "I'm going to limit my meals to 2-3 per day to reduce acid secretion." 2 / 4

CORRECT - Large meals increase the volume and pressure in the stomach and delay gastric emptying. It's recommended instead to eat 4-6 small meals a day.

• "I'm going to make sure to remain upright after meals and elevate my head when

I sleep" Incorrect - This is a correct verbalization of health promotion for GERD.

• "I won't be drinking tea or coffee or eating chocolate any more."

Incorrect - This is a correct verbalization of health promotion for GERD.

• "I'm going to start trying to lose some weight."

Incorrect - This is a correct verbalization of health promotion for GERD.The nurse in the Emergency Room is treating a patient suspected to have a Peptic Ulcer. On assessing lab results, the nurse finds that the patient's blood pressure is 95/60, pulse is 110 beats per minute, and the patient reports epigastric pain. What is the PRIORITY intervention?

• Start a large-bore IV in the patient's arm
• Ask the patient for a stool sample
• Prepare to insert an NG Tube
• Administer intramuscular morphine sulphate as ordered - ANSWER - -
• Start a large-bore IV in the patient's arm

CORRECT - The nurse should suspect that the patient is haemorrhaging and will need need a fluid replacement therapy, which requires a large bore IV.

• Ask the patient for a stool sample

Incorrect - While this is useful in the diagnosis and assessment of Peptic Ulcer Disease, it is not the priority intervention.

• Prepare to insert an NG Tube

Incorrect - While this intervention may be used in the later stages of Peptic Ulcer Disease, it is not the first and priority intervention.

• Administer intramuscular morphine sulphate as ordered 3 / 4

Incorrect - While this is an important intervention to manage pain, it is not the priority intervention.A female patient with atrial fibrillation has the following lab results: Hemoglobin of 11 g/dl, a platelet count of 150,000, an INR of 2.5, and potassium of 2.7 mEq/L.Which result is critical and should be reported to the physician immediately?

• Hemoglobin 11 g/dl
• Platelet of 150,000
• INR of 2.5
• Potassium of 2.7 mEq/L - ANSWER - - 1. Hemoglobin

11 g/dl This is below normal, but a normal female hemoglobin is 12-14. There is a more critical lab result.

• Platelet of 150,000

This is also below the normal values, but is not the most critical lab result.

• INR of 2.5

This is a therapeutic range for a patient who is taking an anticoagulant for atrial fibrillation

• Potassium of 2.7 mEq/L

CORRECT - A potassium imbalance for a patient with a history of dysrhythmia can be life-threatening and can lead to cardiac distress.While receiving normal saline infusions to treat a GI bleed, the nurse notes that the patient's lower legs have become edematous and auscultates crackles in the lungs.What should the nurse do first?

• Stop the saline infusion immediately
• Notify Physician
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