NCLEX-PN Review Questions

NCLEX-PN Review Questions

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 - 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
• Hyperthermia - 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?

• "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." - 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 - 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 - 4. 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
• Elevate the patient's legs
• Continue the infusion, since these are normal findings - 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 - 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

• Stay with the woman until help comes - 3. Ask the woman if she carries an emergency

medical kit CORRECT - Many patients who have a known history of anaphylaxis carry epi-pens in their pockets or belongings. This is the best way to stop a hypersensitivity reaction before it becomes life-threatening.

A man is prescribed lithium to treat bipolar disorder. The nurse is most concerned about lithium toxicity when he notices which of these assessment findings?

• The patient states he had a manic episode a week ago
• The patient states he has been having diarrhea every day
• The patient has a rashy pruritis on his arms and legs
• The patient presents as severely depressed
• The patient's lithium level is 1.3 mcg/L - 2. The patient states he has been having diarrhea

every day Correct - Persistent diarrhea can lead to dehydration, which can increase the risk of lithium toxicity.

A 65 year old man is prescribed Flomax (Tamsulosin) for Benign Prostatic Hyperplasia. The patient lives in an upstairs apartment. The nurse is most concerned about which side effect of Flomax?

• Hypotension
• Tachycardia
• Back Pain
• Difficulty Urinating - 1. Hypotension

Correct - Hypotension can lead to dizziness and a risk for injury to the patient.

A man is receiving heparin subcutaneously. The patient has dementia and lives at home with a part-time caretaker. The nurse is most concerned about which side effect of heparin?

• Back Pain
• Fever and Chills
• Risk for Bleeding
• Dizziness - 3. Risk for Bleeding

Correct - A confused patient is at risk for injuring themselves and at risk for hemorrhage should an injury occur

A female patient is prescribed metformin for glucose control. The patient is on NPO status pending a diagnostic test. The nurse is most concerned about which side effect of metformin?

• Diarrhea and Vomiting
• Dizziness and Drowsiness
• Metallic taste
• Hypoglycemia - 4. Hypoglycemia

Correct - The patient is at risk because she is on NPO status and continuing to take an anti- glycemic drug.

The nurse is reviewing the lab results of a patient taking lithium for schizoaffective disorder. The lab results show that the blood lithium value is 1.7 mcg/L. What would the nurse take as the priority action?

• Induce vomiting
• Hold the next dose of Lithium
• Administer an anti-emetic
• Give the next dose of Lithium - 2. Hold the next dose of Lithium

Correct - Lithium's therapeutic range is 0.5-1.5mcg/L, and begins toxicity at 1.5mcg/L

A patient asks the nurse why they must have a heparin injection. What is the nurse's best response?

• "Heparin will dissolve clots that you have."
• "Heparin will reduce the platelets that make your blood clot"
• "Heparin will work better than warfarin."
• "Heparin will prevent new clots from developing." - 4. "Heparin will prevent new clots from

developing." Correct -This is a correct statement.

The nurse is reviewing the lab results of a patient who has presented in the Emergency Room.The lab results show that the troponin T value is at 5.3 ng/mL. Which of these interventions, if not completed already, would take priority over the others?

• Put the patient in a 90 degree position
• Check whether the patient is taking diuretics
• Obtain and attach defibrillator leads
• Check the patient's last ejection fraction - 3. Obtain and attach defibrillator leads

Correct - This patient is undergoing an emergency cardiac event. Normal Troponin T levels are less than 0.2 ng/mL. Ventricular Fibrillation is the cause of death in most cases of deaths due to sudden cardiac arrest. Defibrillation is the most important action to take to prevent death.

A nurse is caring for a patient undergoing a stress test on a treadmill. The patient turns to talk to the nurse. Which of these statements would require the most immediate intervention?

• "I'm feeling extremely thirsty. I'm going to get some water after this."
• "I can feel my heart racing."
• "My shoulder and arm is hurting."
• "My blood pressure reading is 158/80" - 3. "My shoulder and arm is hurting."

Correct - Unilateral arm and shoulder pain is one of the classic symptoms of myocardial ischemia. The stress test should be halted.