NCLEX- PN Practice Exam 6

1. The physician has ordered Stadol (butorphanol) for a post-operative client. The nurse knows that the medication is having its intended effect if the client:

1. Is asleep 30 minutes after the injection
2. Asks for extra servings on his meal tray
3. Has an increased urinary output
4. States that he is feeling less nauseated

2. The mother of a child with cystic fibrosis tells the nurse that her child makes “snoring” sounds when breathing. The nurse is aware that many children with cystic fibrosis have:

1. Choanal atresia
2. Nasal polyps
3. Septal deviations
4. Enlarged adenoids

3. A client is hospitalized with hepatitis A. Which of the client’s regular medications is contraindicated due to the current illness?

1. Prilosec (omeprazole)
2. Synthroid (levothyroxine)
3. Premarin (conjugated estrogens)
4. Lipitor (atorvastatin)

4. The nurse has been teaching the role of diet in regulating blood pressure to a client with hypertension. Which meal selection indicates that the client understands his new diet?

1. Cornflakes, whole milk, banana, and coffee
2. Scrambled eggs, bacon, toast, and coffee
3. Oatmeal, apple juice, dry toast, and coffee
4. Pancakes, ham, tomato juice, and coffee

5. An 18-month-old is being discharged following hypospadias repair. Which instruction should be included in the nurse’s discharge teaching?

1. The child should not play on his rocking horse.
2. Applying warm compresses to decrease pain.
3. Diapering should be avoided for 1–2 weeks.
4. The child will need a special diet to promote healing.

6. An obstetrical client calls the clinic with complaints of morning sickness. The nurse should tell the client to:

1. Keep crackers at the bedside for eating before she arises
2. Drink a glass of whole milk before going to sleep at night
3. Skip breakfast but eat a larger lunch and dinner
4. Drink a glass of orange juice after adding a couple of teaspoons of sugar

7. The nurse has taken the blood pressure of a client hospitalized with methicillin-resistant staphylococcus aureus. Which action by the nurse indicates an understanding regarding the care of clients with MRSA?

1. The nurse leaves the stethoscope in the client’s room for future use.
2. The nurse cleans the stethoscope with alcohol and returns it to the exam room.
3.  The nurse uses the stethoscope to assess the blood pressure of other assigned clients.
4. The nurse cleans the stethoscope with water, dries it, and returns it to the nurse’s station.

8. The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism. The nurse can reinforce the physician’s teaching by telling the parents that:

1.  The medication will be needed only during times of rapid growth.
2.  The medication will be needed throughout the child’s lifetime.
3. The medication schedule can be arranged to allow for drug holidays.
4. The medication is given one time daily every other day.

9. A client with diabetes mellitus has a prescription for Glucotrol XL (glipizide). The client should be instructed to take the medication:

1.  At bedtime
2.  With breakfast
3.  Before lunch
4. After dinner

10. The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis?

1. Visual disturbances, including diplopia
2. Ascending paralysis and loss of motor function
3. Cogwheel rigidity and loss of coordination
4. Progressive weakness that is worse at the day’s end

11. The nurse is teaching the parents of a newborn with osteogenesis imperfecta. The nurse should tell the parents:

1. That the baby will need daily calcium supplements
2. To lift the baby by the buttocks when diapering
3. That the condition is a temporary one
4. That only the bones are affected by the disease

12. Physician’s orders for a client with acute pancreatitis include the following: strict NPO, NG tube to low intermittent suction. The nurse recognizes that these interventions will:

1. Reduce the secretion of pancreatic enzymes
2. Decrease the client’s need for insulin
3. Prevent secretion of gastric acid
4. Eliminate the need for analgesia

13. A client with diverticulitis is admitted with nausea, vomiting, and dehydration. Which finding suggests a complication of diverticulitis?

1. Pain in the left lower quadrant
2. Boardlike abdomen
3. Low-grade fever
4. Abdominal distention

14. The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is:

1. Prostigmine (neostigmine)
2. Atropine (atropine sulfate)
3. Didronel (etidronate)
4. Tensilon (edrophonium)

15. A client with AIDS complains of a weight loss of 20 pounds in the past month. Which diet is suggested for the client with AIDS?

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

16. The nurse is caring for a 4-year-old with cerebral palsy. Which nursing intervention will help ready the child for rehabilitative services?

1. Patching one of the eyes to strengthen the muscles
2.  Providing suckers and pinwheels to help strengthen tongue movement
3. Providing musical tapes to provide auditory training
4. Encouraging play with a video game to improve muscle coordination

17. At the 6-week check-up, the mother asks when she can expect the baby to sleep all night. The nurse should tell the mother that most infants begin to sleep all night by age:

1. 1 month
2. 2 months
3. 3–4 months
4. 5–6 months

18. Which of the following pediatric clients is at greatest risk for latex allergy?

1. The child with a myelomeningocele
2. The child with epispadias
3. The child with coxa plana
4. The child with rheumatic fever

19. The nurse is teaching the mother of a child with cystic fibrosis how to do postural drainage. The nurse should tell the mother to:

1. Use the heel of her hand during percussion
2. Change the child’s position every 20 minutes
3. Do percussion after the child eats and at bedtime
4. Use cupped hands during percussion

20. The nurse calculates the amount of an antibiotic for injection to be given to an infant. The amount of medication to be administered is 1.25mL. The nurse should:

1. Divide the amount into two injections and administer in each vastus lateralis muscle
2. Give the medication in one injection in the dorsogluteal muscle
3. Divide the amount in two injections and give one in the ventrogluteal muscle and one in the vastus lateralis muscle
4. Give the medication in one injection in the ventrogluteal muscle

21. A client with schizophrenia is receiving depot injections of Haldol Deconate (haloperidol decanoate). The client should be told to return for his next injection in:

1. 1 week
2. 2 weeks
3. 4 weeks
4. 6 weeks

22. A 3-year-old is immobilized in a hip spica cast. Which discharge instruction should be given to the parents?

1. Keep the bed flat, with a small pillow beneath the cast
2. Provide crayons and a coloring book for play activity
3. Increase her intake of high-calorie foods for healing
4. Tuck a disposable diaper beneath the cast at the perineal opening

23. The nurse is caring for a client following the reimplantation of the thumb and index finger. Which finding should be reported to the physician immediately?

1. Temperature of 100°F
2. Coolness and discoloration of the digits
3. Complaints of pain
4. Difficulty moving the digits

24. When assessing the urinary output of a client who has had extracorporeal lithotripsy, the nurse can expect to find:

1. Cherry-red urine that gradually becomes clearer
2. Orange-tinged urine containing particles of calculi
3. Dark red urine that becomes cloudy in appearance
4. Dark, smoky-colored urine with high specific gravity

25. The physician has prescribed Cognex (tacrine) for a client with dementia. The nurse should monitor the client for adverse reactions, which include:

1. Hypoglycemia
2. Jaundice
3. Urinary retention
4. Tinnitus

Answers and Rationales

1. Answer A is correct. Stadol reduces the perception of pain, which allows the post-operative client to rest. Answers B and C are not affected by the medication; therefore, they are incorrect. Relief of pain generally results in less nausea, but it is not the intended effect of the medication; therefore, answer D is incorrect.
2.  Answer B is correct. Children with cystic fibrosis are susceptible to chronic sinusitis and nasal polyps, which might require surgical removal. Answer A is incorrect because it is a congenital condition in which there is a bony obstruction between the nares and the pharynx. Answers C and D are not specific to the child with cystic fibrosis; therefore, they are incorrect.
3. Answer D is correct. Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.
4. Answer C is correct. Oatmeal is low in sodium and high in fiber. Limiting sodium intake and increasing fiber helps to lower cholesterol levels, which reduce blood pressure. Answer A is incorrect because cornflakes and whole milk are higher in sodium and are poor sources of fiber. Answers B and D are incorrect because they contain animal proteins that are high in both cholesterol and sodium.
5. Answer A is correct. The child will need to avoid straddle toys, swimming, and rough play until allowed by the surgeon. Answers B, C, and D do not relate to the post-operative care of the child with hypospadias; therefore, they are incorrect.
6. Answer A is correct. Eating a carbohydrate source such as dry crackers or toast before arising helps alleviate symptoms of morning sickness. Answer B is incorrect because the additional fat might increase the client’s nausea. Answer C is incorrect because the client does not need to skip meals. Answer D is the treatment of hypoglycemia, not morning sickness; therefore, it is incorrect.
7. Answer A is correct. The stethoscope should be left in the client’s room for future use. The stethoscope should not be returned to the exam room or the nurse’s station; therefore, answers B and D are incorrect. The stethoscope should not be used to assess other clients; therefore, answer C is incorrect.
8. Answer B is correct. The medication will be needed throughout the child’s lifetime. Answers A, C, and D contain inaccurate statements; therefore, they are incorrect.
9. Answer B is correct. Glucotrol XL is given once a day with breakfast. Answer A is incorrect because the client would develop hypoglycemia while sleeping. Answers C and D are incorrect because the client would develop hypoglycemia later in the day or evening.
10. Answer D is correct. The client with myasthenia develops progressive weakness that worsens during the day. Answer A is incorrect because it refers to symptoms of multiple sclerosis. Answer B is incorrect because it refers to symptoms of Guillain Barre syndrome. Answer C is incorrect because it refers to Parkinson’s disease.
11. Answer B is correct. To prevent fractures, the parents should lift the baby by the buttocks rather than the ankles when diapering. Answer A is incorrect because children with osteogenesis imperfecta have normal calcium and phosphorus levels. Answer C is incorrect because the condition is not temporary. Answer D is incorrect because the teeth and the sclera are also affected.
12. Answer A is correct. Placing the client on strict NPO status will stop the inflammatory process by reducing the secretion of pancreatic enzymes. The use of low, intermittent suction prevents release of secretion in the duodenum. Answer B is incorrect because the client requires exogenous insulin. Answer C is incorrect because it does not prevent the secretion of gastric acid. Answer D is incorrect because it does not eliminate the need for analgesia.
13. Answer B is correct. A rigid or boardlike abdomen is suggestive of peritonitis, which is a complication of diverticulitis. Answers A, C, and D are common findings in diverticulitis; therefore, they are incorrect.
14. Answer A is correct. Protigmine is used to treat clients with myasthenia gravis. Answer B is incorrect because it is used to reverse the effects of neostigmine. Answer C is incorrect because the drug is unrelated to the treatment of myasthenia gravis. Answer D is incorrect because it is the test for myasthenia gravis.
15. Answer D is correct. The suggested diet for the client with AIDS is one that is high calorie, high protein, and low fat. Clients with AIDS have a reduced tolerance to fat because of the disease as well as side effects from some antiviral medications; therefore, answers A and C are incorrect. Answer B is incorrect because the client needs a high-protein diet.
16. Answer B is correct. The nurse can help ready the child with cerebral palsy for speech therapy by providing activities that help the child develop tongue control. Most children with cerebral palsy have visual and auditory difficulties that require glasses or hearing devices rather than rehabilitative training; therefore, answers A and C are incorrect. Answer D is incorrect because video games are not appropriate for the age or developmental level of the child with cerebral palsy.
17. Answer C is correct. Most infants begin nocturnal sleep lasting 9–11 hours by 3–4 months of age. Answers A and B are incorrect because the infant is still waking for nighttime feedings. Answer D is incorrect because it does not answer the question.
18. Answer A is correct. The child with myelomenigocele is at greatest risk for the development of latex allergy because of repeated exposure to latex products during surgery and from numerous urinary catheterizations. Answers B, C, and D are much less likely to be exposed to latex; therefore, they are incorrect.
19. Answer D is correct. The nurse or parent should use a cupped hand when performing chest percussion. Answer A is incorrect because the hand should be cupped. Answer B is incorrect because the child’s position should be changed every 5–10 minutes and the whole session should be limited to 20 minutes. Answer C is incorrect because chest percussion should be done before meals.
20. Answer A is correct. No more than 1mL should be given in the vastus lateralis of the infant. Answers B, C, and D are incorrect because the dorsogluteal and ventrogluteal muscles are not used for injections in the infant.
21. Answer C is correct. Depot injections of Haldol are administered every 4 weeks. Answers A and B are incorrect because the medication is still in the client’s system. Answer D is incorrect because the medication has been eliminated from the client’s system, which allows the symptoms of schizophrenia to return.
22. Answer D is correct. Tucking a disposable diaper at the perineal opening will help prevent soiling of the cast by urine and stool. Answer A is incorrect because the head of the bed should be elevated. Answer B is incorrect because the child can place the crayons beneath the cast, causing pressure areas to develop. Answer C is incorrect because the child does not need high-calorie foods that would cause weight gain while she is immobilized by the cast.
23. Answer B is correct. Coolness and discoloration of the reimplanted digits indicates compromised circulation, which should be reported immediately to the physician. The temperature should be monitored, but the client would receive antibiotics to prevent infection; therefore, answer A is incorrect. Answers C and D are expected following amputation and reimplantation; therefore, they are incorrect.
24. Answer A is correct. Following extracorporeal lithotripsy, the urine will appear cherry red in color but will gradually change to clear urine. Answer B is incorrect because the urine will be red, not orange. Answer C is incorrect because the urine will be not be dark red or cloudy in appearance. Answer D is incorrect because it describes the urinary output of the client with acute glomerulonephritis.
25. Answer B is correct. An adverse reaction to Cognex is drug-induced hepatitis. The nurse should monitor the client for signs of jaundice. Answers A, C, and D are incorrect because they are not associated with the use of Cognex.