NCLEX-PN 70 REVISION

NCLEX-PN 70+ REVISION

QUESTIONS WITH

DETAILED ANSWERS

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

4. An increased risk of cardiac failure - Answer: 3. Clubbed fingers - CORRECT

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

• Melena
• Nausea
• Hernia

4. 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.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? 1 / 3

• "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: 1. "I'm going to limit my meals to 2-3 per day

to reduce acid secretion." 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.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: 1. 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.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: 4. Potassium of 2.7 mEq/L 2 / 3

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
• Elevate the patient's legs
• Continue the infusion, since these are normal findings - Answer: 1. Stop the saline infusion

immediately CORRECT - the patient has a fluid volume overload as a result of overly rapid fluid replacement. The nurse should stop the infusion and notify the physician.The nurse is working in a support group for clients with HIV. Which point is most important for the nurse to stress?

• They must inform household members of their condition
• They must take their medications exactly as prescribed
• They must abstain from substance use
• They must avoid large crowds - Answer: 2. They must take their medications exactly as prescribed

CORRECT - Antiretrovirals must be taken exactly as prescribed to prevent drug-resistant strains. Even missed doses can reduce the effectiveness of future treatment.A nurse finds a 30-year-old woman experiencing anaphylaxis from a bee sting. Emergency personnel have been called. The nurse notes the woman is breathing but short of breath. Which of the following interventions should the nurse do first?

• Initiate cardiopulmonary resuscitation
• Check for a pulse
• Ask the woman if she carries an emergency medical kit
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