NCLEX Practice Exam 46 (10 Questions)

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  • 1/10 Questions

    An older patient with osteoarthritis is preparing for discharge. Which of the following information is correct.

    • Increased physical activity and daily exercise will help decrease discomfort associated with the condition.
    • Joint pain will diminish after a full night of rest.
    • Nonsteroidal anti-inflammatory medications should be taken on an empty stomach.
    • Acetaminophen (Tylenol) is a more effective anti-inflammatory than ibuprofen (Motrin).
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All questions are shown, but the results will only be given after you’ve finished the quiz. You are given 1 minute per question, a total of 10 minutes in this quiz.

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  • 2. 

    A nurse is performing routine assessment of an IV site in a patient receiving both IV fluids and medications through the line. Which of the following would indicate the need for discontinuation of the IV line as the next nursing action?

    • The patient complains of pain on movement.

    • The area proximal to the insertion site is reddened. warm. and painful.

    • The IV solution is infusing too slowly. particularly when the limb is elevated.

    • A hematoma is visible in the area of the IV insertion site.

    Correct Answer
    A. The area proximal to the insertion site is reddened. warm. and painful.
    Explanation
    An IV site that is red. warm. painful and swollen indicates that phlebitis has developed and the line should be discontinued and restarted at another site. Pain on movement should be managed by maneuvers such as splinting the limb with an IV board or gently shifting the position of the catheter before making a decision to remove the line. An IV line that is running slowly may simply need flushing or repositioning. A hematoma at the site is likely a result of minor bleeding at the time of insertion and does not require discontinuation of the line.

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  • 3. 

    A nurse is evaluating a postoperative patient and notes a moderate amount of serous drainage on the dressing 24 hours after surgery. Which of the following is the appropriate nursing action?

    • Notify the surgeon about evidence of infection immediately.

    • Leave the dressing intact to avoid disturbing the wound site.

    • Remove the dressing and leave the wound site open to air.

    • Change the dressing and document the clean appearance of the wound site.

    Correct Answer
    A. Change the dressing and document the clean appearance of the wound site.
    Explanation
    A moderate amount of serous drainage from a recent surgical site is a sign of normal healing. Purulent drainage would indicate the presence of infection. A soiled dressing should be changed to avoid bacterial growth and to examine the appearance of the wound. The surgical site is typically covered by gauze dressings for a minimum of 48-72 hours to ensure that initial healing has begun.

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  • 4. 

    A hospitalized patient has received transfusions of 2 units of blood over the past few hours. A nurse enters the room to find the patient sitting up in bed. dyspneic and uncomfortable. On assessment. crackles are heard in the bases of both lungs. probably indicating that the patient is experiencing a complication of transfusion. Which of the following complications is most likely the cause of the patient’s symptoms?

    • Febrile non-hemolytic reaction.

    • Allergic transfusion reaction.

    • Acute hemolytic reaction.

    • Fluid overload.

    Correct Answer
    A. Fluid overload.
    Explanation
    Fluid overload occurs when then the fluid volume infused over a short period is too great for the vascular system. causing fluid leak into the lungs. Symptoms include dyspnea. rapid respirations. and discomfort as in the patient described. Febrile non-hemolytic reaction results in fever. Symptoms of allergic transfusion reaction would include flushing. itching. and a generalized rash. Acute hemolytic reaction may occur when a patient receives blood that is incompatible with his blood type. It is the most serious adverse transfusion reaction and can cause shock and death.

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  • 5. 

    A nurse is counseling the mother of a newborn infant with hyperbilirubinemia. Which of the following instructions by the nurse is NOT correct?

    • Continue to breastfeed frequently. at least every 2-4 hours.

    • Follow up with the infant’s physician within 72 hours of discharge for a recheck of the serum bilirubin and exam.

    • Watch for signs of dehydration. including decreased urinary output and changes in skin turgor.

    • Keep the baby quiet and swaddled. and place the bassinet in a dimly lit area.

    Correct Answer
    A. Keep the baby quiet and swaddled. and place the bassinet in a dimly lit area.
    Explanation
    An infant discharged home with hyperbilirubinemia (newborn jaundice) should be placed in a sunny rather than dimly lit area with skin exposed to help process the bilirubin. Frequent feedings will help to metabolize the bilirubin. A recheck of the serum bilirubin and a physical exam within 72 hours will confirm that the level is falling and the infant is thriving and is well hydrated. Signs of dehydration. including decreased urine output and skin changes. indicate inadequate fluid intake and will worsen the hyperbilirubinemia.

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  • 6. 

    Which of the following strategies is NOT effective for prevention of Lyme disease?

    • Insect repellant on the skin and clothes when in a Lyme endemic area.

    • Long sleeved shirts and long pants.

    • Prophylactic antibiotic therapy prior to anticipated exposure to ticks.

    • Careful examination of skin and hair for ticks following anticipated exposure.

    Correct Answer
    A. Prophylactic antibiotic therapy prior to anticipated exposure to ticks.
    Explanation
    Prophylactic use of antibiotics is not indicated to prevent Lyme disease. Antibiotics are used only when symptoms develop following a tick bite. Insect repellant should be used on skin and clothing when exposure is anticipated. Clothing should be designed to cover as much exposed area as possible to provide an effective barrier. Close examination of skin and hair can reveal the presence of a tick before a bite occurs.

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  • 7. 

    A patient returns to the emergency department less than 24 hours after having a fiberglass cast applied for a fractured right radius. Which of the following patient complaints would cause the nurse to be concerned about impaired perfusion to the limb?

    • Severe itching under the cast.

    • Severe pain in the right shoulder.

    • Severe pain in the right lower arm.

    • Increased warmth in the fingers.

    Correct Answer
    A. Severe pain in the right lower arm.
    Explanation
    Impaired perfusion to the right lower arm as a result of a closed cast may cause neurovascular compromise and severe pain. requiring immediate cast removal. Itching under the cast is common and fairly benign. Neurovascular compromise in the arm would not cause pain in the shoulder. as perfusion there would not be affected. Impaired perfusion would cause the fingers to be cool and pale. Increased warmth would indicate increased blood flow or infection.

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  • 8. 

    A nurse is giving discharge instructions to the parents of a healthy newborn. Which of the following instructions should the nurse provide regarding car safety and the trip home from the hospital?

    • The infant should be restrained in an infant car seat. properly secured in the back seat in a rear-facing position.

    • The infant should be restrained in an infant car seat. properly secured in the front passenger seat.

    • The infant should be restrained in an infant car seat facing forward or rearward in the back seat.

    • For the trip home from the hospital. the parent may sit in the back seat and hold the newborn.

    Correct Answer
    A. The infant should be restrained in an infant car seat. properly secured in the back seat in a rear-facing position.
    Explanation
    All infants under 1 year of age weighing less than 20 lbs. should be placed in a rear-facing infant car seat secured properly in the back seat. Infant car seats should never be placed in the front passenger seat. Infants should always be placed in an approved car seat during travel. even on that first ride home from the hospital.

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  • 9. 

    Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis?

    • A female patient being treated for high blood pressure with an ACE inhibitor.

    • A patient who is allergic to iodine/shellfish.

    • A patient on a calorie restricted diet.

    • A patient on bed rest who must maintain a supine position.

    Correct Answer
    A. A patient on bed rest who must maintain a supine position.
    Explanation
    Alendronate can cause significant gastrointestinal side effects. such as esophageal irritation. so it should not be taken if a patient must stay in supine position. It should be taken upon rising in the morning with 8 ounces of water on an empty stomach to increase absorption. The patient should not eat or drink for 30 minutes after administration and should not lie down. ACE inhibitors are not contraindicated with alendronate and there is no iodine allergy relationship.

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  • 10. 

    A patient in labor and delivery has just received an amniotomy. Which of the following is correct? Note: More than one answer may be correct.

    • Frequent checks for cervical dilation will be needed after the procedure.

    • Contractions may rapidly become stronger and closer together after the procedure.

    • The FHR (fetal heart rate) will be followed closely after the procedure due to the possibility of cord compression.

    • The procedure is usually painless and is followed by a gush of amniotic fluid.

    Correct Answer(s)
    A. Contractions may rapidly become stronger and closer together after the procedure.
    A. The FHR (fetal heart rate) will be followed closely after the procedure due to the possibility of cord compression.
    A. The procedure is usually painless and is followed by a gush of amniotic fluid.
    Explanation
    Uterine contractions typically become stronger and occur more closely together following amniotomy. The FHR is assessed immediately after the procedure and followed closely to detect changes that may indicate cord compression. The procedure itself is painless and results in the quick expulsion of amniotic fluid. Following amniotomy. cervical checks are minimized because of the risk of infection

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  • Mar 21, 2023
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  • Jul 16, 2017
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