Vous êtes sur la page 1sur 11

1|Page

NCLEX Practice Exam 13 (20 items)

In Text Mode: All questions and answers are given for reading and
answering at your own pace. You can also copy this exam and make a print
out.

1. A child is admitted to the hospital with a diagnosis of Wilms tumor,


stage II. Which of the following statements most accurately describes this
stage?

A. The tumor is less than 3 cm. in size and requires no chemotherapy.


B. The tumor did not extend beyond the kidney and was completely
resected.
C. The tumor extended beyond the kidney but was completely resected.
D. The tumor has spread into the abdominal cavity and cannot be resected.

2. A teen patient is admitted to the hospital by his physician who suspects


a diagnosis of acute glomerulonephritis. Which of the following findings is
consistent with this diagnosis? Note: More than one answer may be
correct.

A. Urine specific gravity of 1.040.


B. Urine output of 350 ml in 24 hours.
C. Brown (tea-colored) urine.
D. Generalized edema.

3. Which of the following conditions most commonly causes acute


glomerulonephritis?

A. A congenital condition leading to renal dysfunction.


B. Prior infection with group A Streptococcus within the past 10-14 days.
C. Viral infection of the glomeruli.
D. Nephrotic syndrome.

4. An infant with hydrocele is seen in the clinic for a follow-up visit at 1


month of age. The scrotum is smaller than it was at birth, but fluid is still
visible on illumination. Which of the following actions is the physician
likely to recommend?
2|Page

A. Massaging the groin area twice a day until the fluid is gone.
B. Referral to a surgeon for repair.
C. No treatment is necessary; the fluid is reabsorbing normally.
D. Keeping the infant in a flat, supine position until the fluid is gone.

5. A nurse is caring for a patient with peripheral vascular disease (PVD).


The patient complains of burning and tingling of the hands and feet and
cannot tolerate touch of any kind. Which of the following is the most
likely explanation for these symptoms?

A. Inadequate tissue perfusion leading to nerve damage.


B. Fluid overload leading to compression of nerve tissue.
C. Sensation distortion due to psychiatric disturbance.
D. Inflammation of the skin on the hands and feet.

6. A nurse is assessing a clinic patient with a diagnosis of hepatitis A.


Which of the following is the most likely route of transmission?

A. Sexual contact with an infected partner.


B. Contaminated food.
C. Blood transfusion.
D. Illegal drug use.

7. A leukemia patient has a relative who wants to donate blood for


transfusion. Which of the following donor medical conditions would
prevent this?

A. A history of hepatitis C five years previously.


B. Cholecystitis requiring cholecystectomy one year previously.
C. Asymptomatic diverticulosis.
D. Crohns disease in remission.

8. A physician has diagnosed acute gastritis in a clinic patient. Which of


the following medications would be contraindicated for this patient?

A. Naproxen sodium (Naprosyn).


B. Calcium carbonate.
C. Clarithromycin (Biaxin).
D. Furosemide (Lasix).
3|Page

9. The nurse is conducting nutrition counseling for a patient with


cholecystitis. Which of the following information is important to
communicate?

A. The patient must maintain a low calorie diet.


B. The patient must maintain a high protein/low carbohydrate diet.
C. The patient should limit sweets and sugary drinks.
D. The patient should limit fatty foods.

10. A patient admitted to the hospital with myocardial infarction develops


severe pulmonary edema. Which of the following symptoms should the
nurse expect the patient to exhibit?

A. Slow, deep respirations.


B. Stridor.
C. Bradycardia.
D. Air hunger.

11. 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?

A. Notify the surgeon about evidence of infection immediately.


B. Leave the dressing intact to avoid disturbing the wound site.
C. Remove the dressing and leave the wound site open to air.
D. Change the dressing and document the clean appearance of the wound
site.

12. 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?

A. Severe itching under the cast.


B. Severe pain in the right shoulder.
C. Severe pain in the right lower arm.
D. Increased warmth in the fingers.

13. An older patient with osteoarthritis is preparing for discharge. Which


of the following information is correct.
4|Page

A. Increased physical activity and daily exercise will help decrease


discomfort associated with the condition.
B. Joint pain will diminish after a full night of rest.
C. Nonsteroidal anti-inflammatory medications should be taken on an
empty stomach.
D. Acetaminophen (Tylenol) is a more effective anti-inflammatory than
ibuprofen (Motrin).

14. Which patient should NOT be prescribed alendronate (Fosamax) for


osteoporosis?

A. A female patient being treated for high blood pressure with an ACE
inhibitor.
B. A patient who is allergic to iodine/shellfish.
C. A patient on a calorie restricted diet.
D. A patient on bed rest who must maintain a supine position.

15. Which of the following strategies is NOT effective for prevention of


Lyme disease?

A. Insect repellant on the skin and clothes when in a Lyme endemic area.
B. Long sleeved shirts and long pants.
C. Prophylactic antibiotic therapy prior to anticipated exposure to ticks.
D. Careful examination of skin and hair for ticks following anticipated
exposure.

16. 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?

A. The patient complains of pain on movement.


B. The area proximal to the insertion site is reddened, warm, and painful.
C. The IV solution is infusing too slowly, particularly when the limb is
elevated.
D. A hematoma is visible in the area of the IV insertion site.

17. 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
5|Page

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 patients symptoms?

A. Febrile non-hemolytic reaction.


B. Allergic transfusion reaction.
C. Acute hemolytic reaction.
D. Fluid overload.

18. 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.

A. Frequent checks for cervical dilation will be needed after the procedure.
B. Contractions may rapidly become stronger and closer together after the
procedure.
C. The FHR (fetal heart rate) will be followed closely after the procedure due
to the possibility of cord compression.
D. The procedure is usually painless and is followed by a gush of amniotic
fluid.

19. A nurse is counseling the mother of a newborn infant with


hyperbilirubinemia. Which of the following instructions by the nurse is
NOT correct?

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


B. Follow up with the infants physician within 72 hours of discharge for a
recheck of the serum bilirubin and exam.
C. Watch for signs of dehydration, including decreased urinary output and
changes in skin turgor.
D. Keep the baby quiet and swaddled, and place the bassinet in a dimly lit
area.

20. 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?

A. The infant should be restrained in an infant car seat, properly secured in


the back seat in a rear-facing position.
B. The infant should be restrained in an infant car seat, properly secured in
the front passenger seat.
6|Page

C. The infant should be restrained in an infant car seat facing forward or


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

ANSWERS AND RATIONALE

1. Answer: C. The tumor extended beyond the kidney but was completely
resected.

The staging of Wilms tumor is confirmed at surgery as follows: Stage I, the


tumor is limited to the kidney and completely resected; stage II, the tumor
extends beyond the kidney but is completely resected; stage III, residual
non hematogenous tumor is confined to the abdomen; stage IV,
hematogenous metastasis has occurred with spread beyond the abdomen;
and stage V, bilateral renal involvement is present at diagnosis.

2. Answers: A, B, and C

Acute glomerulonephritis is characterized by high urine specific gravity


related to oliguria as well as dark tea colored urine caused by large
amounts of red blood cells. There is periorbital edema, but generalized
edema is seen in nephrotic syndrome, not acute glomerulonephritis.

3. Answer: B. Prior infection with group A Streptococcus within the past


10-14 days.

Acute glomerulonephritis is most commonly caused by the immune


response to a prior upper respiratory infection with group A Streptococcus.
Glomerular inflammation occurs about 10-14 days after the infection,
resulting in scant, dark urine and retention of body fluid. Periorbital edema
and hypertension are common signs at diagnosis.

4. Answer: C. No treatment is necessary; the fluid is reabsorbing normally.

A hydrocele is a collection of fluid in the scrotum that results from a patent


tunica vaginalis. Illumination of the scrotum with a pocket light
demonstrates the clear fluid. In most cases the fluid reabsorbs within the
first few months of life and no treatment is necessary. Massaging the area
7|Page

or placing the infant in a supine position would have no effect. Surgery is


not indicated.

5. Answer: A. Inadequate tissue perfusion leading to nerve damage.

Patients with peripheral vascular disease often sustain nerve damage as a


result of inadequate tissue perfusion. Fluid overload is not characteristic of
PVD. There is nothing to indicate psychiatric disturbance in the patient. Skin
changes in PVD are secondary to decreased tissue perfusion rather than
primary inflammation.

6. Answer: B. Contaminated food.

Hepatitis A is the only type that is transmitted by the fecal-oral route


through contaminated food. Hepatitis B, C, and D are transmitted through
infected bodily fluids.

7. Answer: A. A history of hepatitis C five years previously.

Hepatitis C is a viral infection transmitted through bodily fluids, such as


blood, causing inflammation of the liver. Patients with hepatitis C may not
donate blood for transfusion due to the high risk of infection in the
recipient. Cholecystitis (gallbladder disease), diverticulosis, and history of
Crohns disease do not preclude blood donation.

8. Answer: A. Naproxen sodium (Naprosyn).

Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause


inflammation of the upper GI tract. For this reason, it is contraindicated in a
patient with gastritis. Calcium carbonate is used as an antacid for the relief
of indigestion and is not contraindicated. Clarithromycin is an antibacterial
often used for the treatment of Helicobacter pylori in gastritis. Furosemide
is a loop diuretic and is contraindicated in a patient with gastritis.

9. Answer: D. The patient should limit fatty foods.

Cholecystitis, inflammation of the gallbladder, is most commonly caused by


the presence of gallstones, which may block bile (necessary for fat
absorption) from entering the intestines. Patients should decrease dietary
8|Page

fat by limiting foods like fatty meats, fried foods, and creamy desserts to
avoid irritation of the gallbladder.

10. Answer: D. Air hunger.

Patients with pulmonary edema experience air hunger, anxiety, and


agitation. Respiration is fast and shallow and heart rate increases. Stridor is
noisy breathing caused by laryngeal swelling or spasm and is not associated
with pulmonary edema.

11. Answer: D. Change the dressing and document the clean appearance
of the wound site.

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.

12. Answer: C. Severe pain in the right lower arm.

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.

13. Answer: A. Increased physical activity and daily exercise will help
decrease discomfort associated with the condition.

Physical activity and daily exercise can help to improve movement and
decrease pain in osteoarthritis. Joint pain and stiffness are often at their
worst during the early morning after several hours of decreased movement.
Acetaminophen is a pain reliever, but does not have anti-inflammatory
activity. Ibuprofen is a strong anti-inflammatory, but should always be taken
with food to avoid GI distress.
9|Page

14. Answer: D. A patient on bed rest who must maintain a supine position.

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.

15. Answer: C. Prophylactic antibiotic therapy prior to anticipated


exposure to ticks.

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.

16. Answer: B. The area proximal to the insertion site is reddened, warm,
and painful.

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.

17. Answer: D. Fluid overload.

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
10 | P a g e

receives blood that is incompatible with his blood type. It is the most
serious adverse transfusion reaction and can cause shock and death.

18. Answer: B, C, and D

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

19. Answer: D. Keep the baby quiet and swaddled, and place the bassinet
in a dimly lit area.

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.

20. Answer: A. The infant should be restrained in an infant car seat,


properly secured in the back seat in a rear-facing position.

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.
11 | P a g e