NCLEX-PN Exam Pack Part 8

NCLEX-PN Exam Pack Part 8 Updated 2022

1.1. Question

Which finding is the best indication that a client with ineffective airway clearance needs suctioning?

• Oxygen saturation
• Respiratory rate
• Breath sounds
• Arterial blood gases

Correct Answer: C. Breath sounds

oOption C: Changes in breath sounds such as crackles

are the best indication of the need for suctioning in the client with ineffective airway clearance.

oOptions A, B, and D: They can be altered by other

conditions.2. Question A client with tuberculosis has a prescription for Myambutol (ethambutol HCl). The nurse should tell the client to notify the

doctor immediately if he notices:

• Tingling sensation in the feet
• Changes in hearing
• Red discoloration of bodily fluids
• Changes in color vision

Correct Answer: D. Changes in color vision

oOption D: Myambutol is used in conjunction with at

least one other anti TB drug. An adverse reaction to Myambutol is a change in visual acuity or color vision.

oOption A: Peripheral neuropathy is an adverse effect of

isoniazid.

oOption B: Ototoxicity is an adverse reaction to

Streptomycin.

oOption C: Red discoloration of fluids is a side effect of

Rifampin.3. Question The primary cause of anemia in a client with chronic renal failure

is:

• Poor iron absorption
• Destruction of red blood cells
• Insufficient erythropoietin
• Lack of intrinsic factor

Correct Answer: C. Insufficient erythropoietin

oOption C: Kidneys produce erythropoietin, a hormone

that is responsible for making red blood cells. When a patient has a chronic renal failure, their kidneys are damaged and cannot make enough RBC resulting in anemia.

oOption A: Poor iron absorption will result in iron

deficiency anemia.

oOption B: Destruction of red blood cells usually results

in hemolytic anemia.

oOption D: Lack of intrinsic factor will result in

pernicious anemia and vitamin B12 deficiency.4. Question Which of the following nursing interventions has the highest priority for the client scheduled for an intravenous pyelogram?

• Providing the client with a favorite meal for dinner
• Asking if the client has allergies to shellfish
• Encouraging fluids the evening before the test
• Telling the client what to expect during the test

Correct Answer: B. Asking if the client has allergies to

shellfish

oOption B: The contrast media used during an

intravenous pyelogram contains iodine, which can result in an anaphylactic reaction.

oOptions A, C, and D: They do not relate specifically to

the test.5. Question The doctor has prescribed aspirin 325 mg daily for a client with transient ischemic attacks. The nurse knows that aspirin was

prescribed to:

• Prevent headaches
• Boost coagulation
• Prevent cerebral anoxia
• Keep platelets from clumping together

Correct Answer: D. Keep platelets from clumping together

oOption D: Aspirin prevents the platelets from clumping

together to slow down the blood’s clotting action. It reduces the risk of recurrent stroke when used immediately after a transient ischemic attack.

oOptions A, B, and D: A low-dose aspirin will not

prevent headaches, cerebral anoxia, and boost coagulation.6. Question

A client with tuberculosis asks the nurse how long he will have to

take medication. The nurse should tell the client that:

• Medication is rarely needed after 2 weeks
• He will need to take medication for the rest of his life
• The course of therapy is usually 18–24 months
• He will be re-evaluated in 1 month to see if further

medication is needed

Correct Answer: C. The course of therapy is usually 18–24

months

oOption C: Tuberculosis disease is usually treated with

anti TB meds for 6 to 9 months but If the disease is resistant to drugs, the course of treatment may last longer up to 18 months to 24 months.

oOptions A and D: The treatment time is too brief.

oOption B: The medication is not needed for life.

7. Question Which development milestone puts the 4-month-old infant at greatest risk for injury?

• Switching objects from one hand to another
• Crawling
• Standing
• Rolling over

Correct Answer: D. Rolling over

oOption D: At 4 months of age, the infant can roll over,

which makes it vulnerable to falls from dressing tables or beds without rails.

oOption A: Switching objects from one hand to another

does not prove a threat to safety.