NCLEX- PN Practice Exam 3

1. The nurse is caring for a client with systemic lupus erythematosis (SLE). The major complication associated with systemic lupus erythematosis is:

1. Nephritis
2. Cardiomegaly
3. Desquamation
4.  Meningitis

2. Which diet is associated with an increased risk of colorectal cancer?

1. Low protein, complex carbohydrates
2. High protein, simple carbohydrates
3. High fat, refined carbohydrates
4. Low carbohydrates, complex proteins

3. The nurse is caring for an infant following a cleft lip repair. While comforting the infant, the nurse should avoid:

1. Holding the infant
2. Offering a pacifier
3. Providing a mobile
4.  Offering sterile water

4. The physician has ordered Amoxil (amoxicillin) 500mg capsules for a client with esophageal varices. The nurse can best care for the client’s needs by:

1. Giving the medication as ordered
2. Providing extra water with the medication
3. Giving the medication with an antacid
4. Requesting an alternate form of the medication

5. The nurse is providing dietary instructions for a client with iron-deficiency anemia. Which food is a poor source of iron?

1. Tomatoes
2. Legumes
3. Dried fruits
4. Nuts

6. The nurse is teaching a client with Parkinson’s disease ways to prevent curvatures of the spine associated with the disease. To prevent spinal flexion, the nurse should tell the client to:

1. Periodically lie prone without a neck pillow
2. Sleep only in dorsal recumbent position
3. Rest in supine position with his head elevated
4. Sleep on either side but keep his back straight

7. The nurse is planning dietary changes for a client following an episode of pancreatitis. Which diet is suitable for the client?

1. Low calorie, low carbohydrate
2. High calorie, low fat
3. High protein, high fat
4. Low protein, high carbohydrate

8. A client with hypothyroidism frequently complains of feeling cold. The nurse should tell the client that she will be more comfortable if she:

1. Uses an electric blanket at night
2. Dresses in extra layers of clothing
3. Applies a heating pad to her feet
4. Takes a hot bath morning and evening

9. A client has been hospitalized with a diagnosis of laryngeal cancer. Which factor is most significant in the development of laryngeal cancer?

1. A family history of laryngeal cancer
2. Chronic inhalation of noxious fumes
3. Frequent straining of the vocal cords
4. A history of alcohol and tobacco use

10. The nurse is completing an assessment history of a client with pernicious anemia. Which complaint differentiates pernicious anemia from other types of anemia?

1. Difficulty in breathing after exertion
2. Numbness and tingling in the extremities
3. A faster-than-usual heart rate
4. Feelings of lightheadedness

11. The chart of a client with schizophrenia states that the client has echolalia. The nurse can expect the client to:

1. Speak using words that rhyme
2. Repeat words or phrases used by others
3. Include irrelevant details in conversation
4. Make up new words with new meanings

12. Which early morning activity helps to reduce the symptoms associated with rheumatoid arthritis?

1. Brushing the teeth
2. Drinking a glass of juice
3. Drinking a cup of coffee
4. Brushing the hair

13. A newborn weighed 7 pounds at birth. At 6 months of age, the infant could be expected to weigh:

1. 14 pounds
2. 18 pounds
3. 25 pounds
4.  30 pounds

14. A client with nontropical sprue has an exacerbation of symptoms. Which meal selection is responsible for the recurrence of the client’s symptoms?

1. Tossed salad with oil and vinegar dressing
2. Baked potato with sour cream and chives
3. Cream of tomato soup and crackers
4. Mixed fruit and yogurt

15. A client with congestive heart failure has been receiving Digoxin (lanoxin). Which finding indicates that the medication is having a desired effect?

1. Increased urinary output
2. Stabilized weight
3. Improved appetite
4. Increased pedal edema

16. Which play activity is best suited to the gross motor skills of the toddler?

1. Coloring book and crayons
2. Ball
3. Building cubes
4. Swing set

17. The physician has ordered Basalgel (aluminum carbonate gel) for a client with recurrent indigestion. The nurse should teach the client common side effects of the medication, which include:

1. Constipation
2. Urinary retention
3. Diarrhea
4. Confusion

18. A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aortic aneurysm is:

1. Loss of sensation in the lower extremities
2. Back pain that lessens when standing
3. Decreased urinary output
4. Pulsations in the periumbilical area

19. A client is admitted with acute adrenal crisis. During the intake assessment, the nurse can expect to find that the client has:

1. Low blood pressure
2. Slow, regular pulse
3. Warm, flushed skin
4. Increased urination

20. An elderly client is hospitalized for a transurethral prostatectomy. Which finding should be reported to the doctor immediately?

1. Hourly urinary output of 40–50cc
2. Bright red urine with many clots
3. Dark red urine with few clots
4. Requests for pain med q 4 hrs.

21. A 9-year-old is admitted with suspected rheumatic fever. Which finding is suggestive of polymigratory arthritis?

1. Irregular movements of the extremities and facial grimacing
2. Painless swelling over the extensor surfaces of the joints
3. Faint areas of red demarcation over the back and abdomen
4.  Swelling, inflammation, and effusion of the joints

22. A child with croup is placed in a cool, high-humidity tent connected to room air. The primary purpose of the tent is to:

1. Prevent insensible water loss
2. Provide a moist environment with oxygen at 30%
3. Prevent dehydration and reduce fever
4. Liquefy secretions and relieve laryngeal spasm

23. A client is admitted with a diagnosis of hypothyroidism. An initial assessment of the client would reveal:

1. Slow pulse rate, weight loss, diarrhea, and cardiac failure
2. Weight gain, lethargy, slowed speech, and decreased respiratory rate
3. Rapid pulse, constipation, and bulging eyes
4. Decreased body temperature, weight loss, and increased respirations

24. Which statement describes the contagious stage of varicella?

1. The contagious stage is 1 day before the onset of the rash until the appearance of vesicles.
2. The contagious stage lasts during the vesicular and crusting stages of the lesions.
3. The contagious stage is from the onset of the rash until the rash disappears.
4. The contagious stage is 1 day before the onset of the rash until all the lesions are crusted.

25. A client admitted to the psychiatric unit claims to be the Son of God and insists that he will not be kept away from his followers. The most likely explanation for the client’s delusion is:

1. A religious experience
2. A stressful event
3. Low self-esteem
4. Overwhelming anxiety

Answers and Rationales

1. Answer A is correct. The major complication of SLE is lupus nephritis, which results in end-stage renal disease. SLE affects the musculoskeletal, integumentary, renal, nervous, and cardiovascular systems, but the major complication is renal involvement; therefore, answers B and D are incorrect. Answer C is incorrect because the SLE produces a “butterfly” rash, not desquamation.
2. Answer C is correct. A diet that is high in fat and refined carbohydrates increases the risk of colorectal cancer. High fat content results in an increase in fecal bile acids, which facilitate carcinogenic changes. Refined carbohydrates increase the transit time of food through the gastrointestinal tract and increase the exposure time of the intestinal mucosa to cancer-causing substances. Answers A, B, and D do not relate to the question; therefore, they are incorrect.
3. Answer B is correct. The nurse should avoid giving the infant a pacifier or bottle because sucking is not permitted. Holding the infant cradled in the arms, providing a mobile, and offering sterile water using a Breck feeder are permitted; therefore, answers A, C, and D are incorrect.
4. Answer D is correct. The client with esophageal varices can develop spontaneous bleeding from the mechanical irritation caused by taking capsules; therefore, the nurse should request the medication in a suspension. Answer A is incorrect because it does not best meet the client’s needs. Answer B is incorrect because it is not the best means of preventing bleeding. Answer C is incorrect because the medications should not be given with milk or antacids.
5. Answer A is correct. Tomatoes are a poor source of iron, although they are an excellent source of vitamin C, which increases iron absorption. Answers B, C, and D are good sources of iron; therefore, they are incorrect.
6. Answer A is correct. Periodically lying in a prone position without a pillow will help prevent the flexion of the spine that occurs with Parkinson’s disease. Answers B and C flex the spine; therefore, they are incorrect. Answer D is not realistic because of position changes during sleep; therefore, it is incorrect.
7. Answer B is correct. The client recovering from pancreatitis needs a diet that is high in calories and low in fat. Answers A, C, and D are incorrect because they can increase the client’s discomfort.
8. Answer B is correct. Dressing in layers and using extra covering will help decrease the feeling of being cold that is experienced by the client with hypothyroidism. Decreased sensation and decreased alertness are common in the client with hypothyroidism; therefore, the use of electric blankets and heating pads can result in burns, making answers A and C incorrect. Answer D is incorrect because the client with hypothyroidism has dry skin, and a hot bath morning and evening would make her condition worse.
9. Answer D is correct. A history of frequent alcohol and tobacco use is the most significant factor in the development of cancer of the larynx. Answers A, B, and C are also factors in the development of laryngeal cancer, but they are not the most significant; therefore, they are incorrect.
10. Answer B is correct. Numbness and tingling in the extremities is common in the client with pernicious anemia, but not those with other types of anemia. Answers A, C, and D are incorrect because they are symptoms of all types of anemia.
11. Answer B is correct. The client with echolalia repeats words or phrases used by others. Answer A is incorrect because it refers to clang association. Answer C is incorrect because it refers to circumstantiality. Answer D is incorrect because it refers to neologisms.
12. Answer C is correct. Holding a cup of coffee or hot chocolate helps to relieve the pain and stiffness of the hands. Answers A, B, and D do not relieve the symptoms of rheumatoid arthritis; therefore, they are incorrect.
13. Answer A is correct. The infant’s birth weight should double by 6 months of age. Answers B, C, and D are incorrect because they are greater than the expected weight gain by 6 months of age.
14. Answer C is correct. The symptoms of nontropical sprue and celiac are caused by the ingestion of gluten, which is found in wheat, oats, barley, and rye. Creamed soup and crackers contain gluten. Answers A, B, and D do not contain gluten; therefore, they are incorrect.
15.  Answer A is correct. Lanoxin slows and strengthens the contraction of the heart. An increase in urinary output shows that the medication is having a desired effect by eliminating excess fluid from the body. Answer B is incorrect because the weight would decrease. Answer C might occur but is not directly related to the question; therefore, it is incorrect. Answer D is incorrect because pedal edema would decrease, not increase.
16. Answer B is correct. The toddler has gross motor skills suited to playing with a ball, which can be kicked forward or thrown overhand. Answers A and C are incorrect because they require fine motor skills. Answer D is incorrect because the toddler lacks gross motor skills for play on the swing set.
17. Answer A is correct. Antacids containing aluminum and calcium tend to cause constipation. Answer A refers to the side effects of anticholinergic medications used to treat ulcers; therefore, it is incorrect. Answer C refers to antacids containing magnesium; therefore, it is incorrect. Answer D refers to dopamine antagonists used to treat ulcers; therefore, it is incorrect.
18. Answer D is correct. The client with an abdominal aortic aneurysm frequently complains of pulsations or “feeling my heart beat” in the abdomen. Answers A and C are incorrect because they occur with rupture of the aneurysm. Answer B is incorrect because back pain is not affected by changes in position.
19. Answer A is correct. The client with acute adrenal crisis has symptoms of hypovolemia and shock; therefore, the blood pressure would be low. Answer B is incorrect because the pulse would be rapid and irregular. Answer C is incorrect because the skin would be cool and pale. Answer D is incorrect because the urinary output would be decreased.
20. Answer B is correct. Bright red bleeding with many clots indicates arterial bleeding that requires surgical intervention. Answer A is within normal limits; therefore, it is incorrect. Answer C indicates venous bleeding, which can be managed by nursing intervention; therefore, it is incorrect. Answer D does not indicate excessive need for pain management that requires the doctor’s attention; therefore, it is incorrect.
21. Answer D is correct. The child with polymigratory arthritis will exhibit swollen, painful joints. Answer B is incorrect because it describes subcutaneous nodules. Answer C is incorrect because it describes erythema marginatum. Answer A is incorrect because it describes Syndeham’s chorea.
22. Answer D is correct. The primary reason for placing a child with croup under a mist tent is to liquefy secretions and relieve laryngeal spasms. Answer A is incorrect because it does not prevent insensible water loss. Answer B is incorrect because the oxygen concentration is too high. Answer C is incorrect because the mist tent does not prevent dehydration or reduce fever.
23. Answer B is correct. Symptoms of hypothyroidism include weight gain, lethargy, slow speech, and decreased respirations. Answers A and D do not describe symptoms associated with myxedema; therefore, they are incorrect. Answer C describes symptoms associated with Graves’s disease; therefore, it is incorrect.
24. Answer D is correct. The contagious stage of varicella begins 24 hours before the onset of the rash and lasts until all the lesions are crusted. Answers A, B, and C are inaccurate regarding the time of contagion; therefore, they are incorrect.
25. Answer C is correct. Delusions of grandeur are associated with low self-esteem. Answer A is incorrect because conversion is expressed as sensory or motor deficits. Answers B and C can cause an increase in the client’s delusions but do not explain their purpose; therefore, they are incorrect.