NCLEX Preparation Course - Critical Thinking Exercises V (Questions 1-10)

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Here are the Answers to NCLEX Preparation Course - Critical Thinking V (1-10) -->

1. Which of the following statements when made by the client who had undergone vasectomy indicates understanding of the procedure?

a) it is safe to have unprotected sex a week after the procedure
b) I should have 3 negative semen analysis before being considered sterile
c) I am considered sterile immediately after the procedure
d) I should have protected sex for 6 months after the procedure

2. Septic shock is caused by

a) massive blood loss
b) compromised myocardial contractility
c) interruption of the sympathetic nervous system
d) release of bacterial toxin in the blood vessel

3. The client is unresponsive to being shaken and to loud voice. What is the next nursing action?

a) initiate painful stimuli
b) initiate external chest compression
c) initiate mechanical ventilation
d) initiate rescue breathing

4. Which of the following is a sign of improvement in a client with anasarca?

a) decrease in blood pressure
b) decrease in body temperature
c) decrease in edema
d) decrease in pulse rate

5. The patient with carpal tunnel syndrome is being fitted for splint. What should be the position of the hand?

a) flexed position
b) neutral position
c) hyperextended position
d) supinated position

6. Which of the following laboratory results should be reported to the physician first?

a) serum potassium is 4.0 mEq/L
b) serum calcium is 9 mg/dL
c) serum magnesium is 2.1 mEq/L
d) serum sodium is 165 mEq/L

7. The client had been diagnosed to have systemic lupus erythematosus (SLE). Which of the following assessment findings should the nurse watch out for?

a) pericardial friction rub
b) elevated blood pressure
c) tachycardia
d) hemoptysis

8. Which of the following information is true with sickle cell anemia?

a) it affects the sons only
b) it is inherited from both parents
c) daughters will not develop the disease, they will only be carriers
d) the trait carriers will develop the disease as they grow old

9. Which of the following is an example of breach of a patient's constitutional right to privacy?

a) nurse A discusses a patient's history with other staff to plan for continuity of care
b) nurse B releases information to a patient's employer regarding his condition without the patient's consent
c) nurse C documents in detail a patient's daily behaviors during his hospitalization
d) nurse D asks the patient's family members to share information about his prehospitalization behavior

10. A client has arterial blood gas results of pH=7.30, pO2=58, pCO2=34, HCO3=19. What acid-base imbalance would these results most likely indicate?

a) metabolic acidosis
b) metabolic alkalosis
c) respiratory acidosis
d) respiratory alkalosis


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NCLEX Preparation Course - Critical Thinking Exercises IV (Answers 21-30)

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Here are the Questions to NCLEX Preparation Course - Critical Thinking IV (21-30) -->

21) D
- elevated alpha-fetoprotein indicates neural tube defects and chromosomal defects.

22) A
- addison's crisis is characterized by acute adrenal insufficiency. It is precipitated by stress, infection, trauma or surgery. It can cause severe hypotension, hyponatremia, hyperkalemia, hypoglycemia and shock.

23) A
- annual digital rectal examination (DRE) is required for males who are over 40 years of age. This is to detect BPH and rectal cancer.

24) D
- pericardial friction rub indicates pericarditis which is a serious complication of SLE and needs follow-up. Choices A, B, and C are characteristic manifestations of the disease.

25) C
- the client who will undergo mammogram should not apply cream, powder, or deodorant in the axillae. These may cause false positive result.

26.) A
- bed rest for 5 to 7 days should be maintained by the client with deep vein thrombosis. This is to prevent dislodgement of blood clot. Massaging the legs should be avoided to prevent dislodgement of blood clots. Compression stockings should be worn by the patient before getting out of bed. The legs should be elevated to promote venous return and relieve edema.

27) C
- adequate hydration prevents further sickling of RBC's. The treatment for sickle cell crisis: H-H-O-P (hydration, heat application, oxygen, pain medication).

28) C
- anaphylactic reaction may occur from antibiotic therapy. Stop the IV infusion of the medication if signs and symptoms of allergic reaction start to occur.

29) B
- the client is not responding to the insulin treatment. Therefore, he should be given priority by the nurse.

30) C
- an adolescent requires well-balanced diet to support his/her nutritional requirements. This is because adolescent stage is characterized by growth spurt.


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NCLEX Kidneys 26-30

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Let us try answering some NCLEX Kidneys Questions . . . 

 28. The client with chronic renal failure is on chronic hemodialysis. Which of the following indicate improvement of the client's condition due to hemodialysis? Select all that apply

a) the client's BP is 130/90
b) the client's serum potassium is 4.8 mEq/L
c) the client's hemoglobin level is 10 g/dL
d) the client's serum calcium is 7.7 mg/dL
f) the client's serum sodium is 140 mEg/L
g) the client's serum magnesium is 4 mEq/L
h) the client's weight has increased from 60 kg to 63 kg

29. The client is in end-stage renal failure (ESRD). Which of the following foods may be allowed for the client?

a) banana
b) apple
c) carrot cake
d) cantaloupe

30. The client has end-stage renal disease. He had undergone kidney transplant 5 days ago. Which of the following is the most important intervention for the client to prevent infection?

a) observe sepsis
b) increase fluid intake
c) avoid clients with flu
d) avoid crowded places




NCLEX Kidneys 
ANSWERS AND RATIONALE

26) A
- cloudy diasylate indicates infection (peritonitis). Culture of the fluid must be done to determine the microorganism present.

27) D
- the client with renal failure should be given low potassium diet because of hyperkalemia. Apple contains very little potassium. So, it can be given to the client.

28) A, B, E
- these values have normalized; therefore they indicate improvement of client's condition on chronic hemodialysis. As edema fluids are removed from the body, there should be decrease in weight. Hemodialysis does not affect hemoglobin levels.

29) B
- the client with ESRD should have low potassium diet to prevent hyperkalemia. Apple has very minimal potassium. Banana, carrot, cantaloupe are rich in potassium.

30) A
- asepsis is the most effective measure to prevent infection.


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NCLEX Review about Cardiac Nursing (21-25)

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NCLEX Review about Cardiac Nursing

21. The client with congestive heart failure develops cardiac tamponade. Which of the following signs and symptoms would the nurse assess?

a) distant or muffled heart sounds
b) hypertension
c) bradycardia
d) increased urine output

22. The nurse is giving health teachings to several clients. Which among these clients is at risk for coronary artery diseases?

a) the client who works in the department store
b) the client who smokes cigarette
c) the client who had her menarche at age 12 years old
d) the client whose serum cholesterol level is 180 mg/dL

23. Which of the following questions is most important to ask in a client with congestive heart failure who has jugular vein distention?

a) at what time do you go to sleep during the night?
b) how many pillows do you use when lying down?
c) what do you drink before going to sleep?
d) how many hours of night sleep do you have?

24. The drug of choice to control premature ventricular contractions, ventricular tachycardia, or ventricular fibrillation is

a) quinidine
b) procainamide
c) bretylium
d) lidocaine

25. Which of the following situations in a client with myocardial infarction (MI) should be given highest priority?

a) the client complains of palpitations
b) the client's BP is 170/95
c) the client has premature ventricular contractions of 4 multifocals/min
d) the client serum enzyme studies are elevated





NCLEX Review about Cardiac Nursing:
ANSWERS AND RATIONALE

21) A
- cardiac tamponade involves accumulation of fluid in the pericardial sac. It restricts ventricular filling and decreases cardiac output. It is characterized by distant, muffled sound, distended neck veins, and diminished or absent pulse (Beck's triad).

22) B
- cigarette smoking is one of the most common risks of CAD (Coronary artery disease).

23) B
- orthopnea, which is difficulty in breathing when in lying position relieved by upright position, is a sign of progressive cardiac disorder.

24) D
- lidocaine is the first line of drug to control PVC's, VT, VF. Lidocaine exerts anesthetic effect on the heart thus decreasing myocardial irritability.

25) B
- elevated BP increases afterload, and therefore increases cardiac workload. This leads to increased myocardial oxygen demand.


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Online Nursing Practice Test about Neurological Disorders (31-35)

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31. The client experiences hypoglossal nerve damage. Which of the following assessment findings does the nurse expect in the client?

a) difficulty of swallowing and protrusion of tongue
b) asymmetry of the face
c) severe pain on the side of the face
d) inability to rotate the head and move shoulders

32. Which of the following indicates stimulation of the sympathetic nervous system (SNS)?

a) hypotension
b) urinary frequency
c) diarrhea
d) dilatation of pupils

33. A client with moderate Alzheimer's disease removes her clothes in the hall. Which of the following is the most appropriate nursing action?

a) help the client put on her dress
b) usher the client back to his room
c) tell the client that such behavior is unacceptable
d) remind her that when she undresses, she should do it inside her room

34. Which of the following nursing interventions should be included in the nursing care plan for the client with cerebral concussion?

a) check leakage of cerebrospinal fluid through the nose
b) check vital signs every 2 hours
c) check neurologic status every 4 hours
d) check pupillary reflexes once in each shift

35. The client who had cerebrovascular accident (CVA) has left-sided weakness. Which of the following instructions should be included regarding proper use of the cane?

a) hold the cane on the right hand
b) hold the cane on the left hand
c) hold the cane alternately on each hand
d) hold the cane with both hands



ANSWERS AND RATIONALE

31) A
- hypoglossal nerve provides motor nerve supply to the tongue. Hypoglossal nerve damage is characterized by difficulty of swallowing, protrusion of the tongue, deviation of the tongue to one side of the mouth.
Asymmetry of the face is affectation of the facial nerve.
Severe pain on the side of the face is affectation of the trigeminal nerve.
Inability to rotate the head and move shoulders is affectation of the spinal accessory nerve.

32) D
- SNS secretes norepinephrine and causes dilatation of pupils. Choices A, B, and C are effects of PNS. (SNS: everything is high and fast, except GI and GU).

33) D
- a client with Alzheimer's disease experiences memory loss. Reminding the client will help him/her remember, e.g. undressing is done inside the room.

34) A
- in head injury, it is very important to assess for CSF leakage. This indicates basilar head injury. This may lead to brainstem compression resulting to cardiopulmonary arrest.

35) A
- use the cane on the stronger/unaffected area - the right hand.


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Test Prep for Nursing Exam about Obstetric Nursing (21-25)

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21. Which of the following indicates that Brethine (Theophylline) is effective in a woman on premature labor?

a) uterine contractions become more frequent
b) uterine contractions stop
c) cervical dilatation progresses
d) rupture of membrane occurs

22. The woman isi n active labor. The presentation of the fetus is left occiput posterior (LOP). Which of the following measures should be included when caring for the client?

a) provide foods and fluids
b) assist the client to ambulate
c) provide back massage
d) allow the client to sleep

23. The postpartum client is bleeding heavily 2 hours after delivery. The fundus of the uterus is firm; uterus at the center of the abdomen. Which of the following actions should the nurse do next?

a) change perineal pads
b) notify the physician
c) massage the uterus
d) check perineum

24. The client is on her second trimester of pregnancy. Her BP is 159/95 mmHg. Which of the following would give clue to make a diagnosis?

a) weight loss
b) increased urine output
c) protein in the urine
d) fundal height at the level of umbilicus

25. Which of the following assessment findings indicates adverse reaction to Morphine Sulfate in a gravida 5 para 5 client?

a) elevated blood pressure
b) increased respiratory rate
c) boggy fundus of the uterus
d) restlessness



ANSWERS AND RATIONALE

21) B
- brethine (theophylline) is a tocolytic agent. It promotes uterine relaxation and prevents premature labor.

22) C
- LOP presentation causes sever back pain to the mother. The head of the fetus causes pressure on nerves in the spinal area. Providing back massage helps relieve the discomfort.

23) D
- postpartal bleeding may be caused by uterine atony, retained placenta, subinvolution, vaginal lacerations, and perineal lacerations.

24) C
- PIH (pregnancy-induced hypertension) is characterized by: hypertension, edema, proteinuria and hyperlipidemia.

25) C
- morphine sulfate causes relaxation of muscles including uterine muscles.


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NCLEX Preparation Course - Critical Thinking Exercises IV (Questions 21-30)

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Here are the Answers to NCLEX Preparation Course - Critical Thinking IV (21-30) -->

21. Which of the following laboratory tests may help diagnose presence of spina bifida?

a) kleihaeur-betke test
b) ABO typing
c) HCG levels determination
d) alpha-fetoprotein

22. Which of the following signs and symptoms indicate that a client is on Addison's crisis?

a) hypotension
b) fever
c) severe hypokalemia
d) severe hyperglycemia

23. Which of the following statements made by a 50-year old male indicates that he understands health teachings about disease prevention?

a) I will have an annual digital rectal examination
b) I will go jogging every weekend
c) I will need to minimize my cigarette smoking
d) I will need to drink 4 glasses of whole milk a day

24. The client had been diagnosed to have systemic lupus erythematosus. Which of the following assessment data needs follow-up?

a) alopecia
b) photosensitivity
c) butterfly rash over the nose and face
d) pericardial friction rub

25. The client will undergo mammogram. Which of the following information should be included by the nurse when preparing the client for the procedure?

a) the procedure is painless
b) you should not eat or drink anything 2 hours before the procedure
c) you should not apply cream, powder, or deodorant in the axillae before the procedure
d) you will lie down on a special table during the procedure

26. Which of the following instructions should be included when caring for a client with deep vein thrombosis (DVT)?
a) do not ambulate
b) massage your legs when painful
c) apply compression stockings while in sitting position
d) dangle your legs while sitting at the side of bed several times a day

27. The child with sickle cell anemia is experiencing vaso-occlusive crisis. Which of the following should the nurse include in the nursing care plan of the client?

a) allow active range-of-motion exercises of the legs
b) apply cold over the legs
c) administer IV fluids as ordered
d) place the client in protective isolation

28. A client is started on an IV antibiotic in the emergency department. He calls the nurse and tells her that he is beginning to itch and has a "scratchy throat". Which of the following interventions would the nurse do first?

a) call the attending physician at once
b) call a code
c) stop the infusion
d) take his vital signs and report them immediately

29. After receiving endorsement, which client should the nurse see first?

a) a client who had cholecystectomy one day ago, and had received analgesic 2 hours ago
b) a client with blood sugar of 380 mg/dL and have recieved 20 units of regular insulin 2 hours ago
c) a client who has blood transfusion and whose vital signs are being monitored by a CNA
d) the client with total parenteral nutrition whose urine is positive for glucose

30. The nurse is giving health teachings on diet to several adolescents. Which among these clients need further teachings regarding diet?

a) the adolescent who takes cereal with milks during breakfast, pizza for lunch, vegetable salad and fruits for dinner
b) the adolescent who takes rice and chicken dish for breakfast, burger and orange juice for lunch, green salad and fruits for dinner
c) the adolescent who skips breakfast, takes soda and burger for lunch, green salad for dinner
d) the adolescent who takes mashed potato and sausage for breakfast, rice and roasted beef for lunch, mixed vegetables and fruits for dinner


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NCLEX Preparation Course - Critical Thinking Exercises IV (Answers 11-20)

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Here are the Questions to NCLEX Preparation Course - Critical Thinking IV (11-20) -->

11) B
- bleeding leads to hypovolemic shock (blood loss of 20% or 1L is fatal).

12) Vesicles

13) C
- the restraints should be secured on the bedframe not on the side rails to prevent trauma on the extremities.

14) B
- the incident report should not be placed in the client's record. The incident should be documented in the client's record, as well.

15) D
- beneficence means doing or promoting good. Choices A, B, and C are practices of nonmaleficence.

16) A
- a nurse floated to another unit should be assigned to a client that requires care similar to his/her experience of training. Blood transfusion can be dealt with by an OB unit nurse.

17) A
- to prevent/minimize pruritus in a client with jaundice, keep the environment cool. Warm environment causes accumulation of perspiration on the skin that worsens pruritus.

18) D
- ginseng is used for relief of stress, to boost energy, give digestive support and support immune system.
Choice A (feverfew) is used to relieve migraine headache
Choice B (aloe vera) is used for skin conditions (burns, insect bites, sunburn, dandruff, psoriasis)
Choice C (cranberry) is used to treat urinary tract infection

19) C
- drinking too much fluid before bedtime will cause nocturia (frequent voiding during the night).

20) A
- monitoring of VS can be done by a CNA. Choices B,C, and D can be assigned to the LVN.


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Test Prep for Nursing Exam about Pediatric Nursing (21-25)

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21. Which of the following toys is inappropriate for an 18-month old child?

a) low rocking horses
b) push-pull toys
c) plastic blocks
d) rattles

22. An infant is 7 months. Which of the following comments when made by the mother indicates normal growth and development of the child?

a) my child is cross-eyed
b) my child can sit up by himself
c) my child puts his toes into his mouth
d) my child starts to crawl

23. The child is undergoing repair of cleft lip and palate. What should the nurse prepare in the room while waiting for the child?

a) papoose board
b) mummy restraint
c) elbow restraint
d) jacket restraint

24. Which of the following situations increase risk of lead poisoning in children?

a) playing in the park with heavy traffic and with many vehicles passing by
b) playing sand in the park
c) playing plastic balls with other children
d) playing with stuffed toys at home

25. The nurse is caring for a child who has intussusception. Which of the following assessment is most important to report to the physician?

a) greasy, bulky, foul-smelling stool
b) pellet-like stool
c) formed stool
d) currant jelly stool



ANSWERS AND RATIONALE

21) D
- rattles are appropriate for an infant. Low rocking horses, push-pull toys, and plastic blocks are appropriate for a toddler.

22) B
- a child who is 6 to 8 months of age is able to sit up. Crossed-eyedness is resolved at 3 to 4 months of age. A 5-month old child is able to put his toes into his mouth. A 9-month old child is able to crawl and creep.

23) C
- elbow restraint should be applied to prevent trauma to the operated area.

24) A
- lead poisoning may be caused by inhalation of dusk and smoke from leaded gas. It may also be caused by lead-based paint, soil, water (especially from plumbings of old houses).

25) C
- formed stool indicates resolution of intussusception. Surgery is no longer indicated.


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Online Nursing Practice Test/Exam about Cancer (16-20)

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16. After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/cu.mm. What term should the nurse use to describe this low platelet count?

17. Which of the following should the nurse include when providing health teachings for patients at risk of developing prostatic cancer?

a) participate in smoking cessation program
b) perform monthly self-testicular examination
c) maintain daily walking exercise
d) undergo monthly digital rectal examination

18. Which of the following questions should the nurse ask in a client who is at risk for breast cancer?

a) does your family have a history of multiple gestation?
b) does your family have a history of ovarian cancer?
c) does your family have a history of early menopause?
d) does your family have a history of late menarche?

19. Which of the following client history increases risk for anorectal cancer?

a) chronic constipation
b) high fiber diet
c) alcohol abuse
d) chronic inflammatory bowel disease

20. A client will be for uterine radium implant. Which of the following statement when made by the client indicates the need for further teaching?

a) my sister is coming to stay with me today after implant insertion
b) I will be in bed for the duration of the treatment
c) I will have a foley catheter in place
d) I will have enema before the procedure



ANSWERS AND RATIONALE

16) thrombocytopenia
- the normal thrombocyte count is 150,000 to 450,000/ cu.mm.

17) A
- smoking increases risk for prostatic cancer. Choice B is done to detect cancer of the testes. Choice D, digital rectal examination is recommended annually, not monthly.

18) B
- history of cancer of the reproductive system (cancer of the uterus, cervix, and ovaries) increase risk for breast cancer.

19) D
- chronic inflammatory bowel disease are primarily associated with anorectal cancer.

20) A
- the client on internal radiation therapy should be on isolation to prevent radiation contamination of other people.


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NCLEX Preparation Course - Critical Thinking Exercises IV (Questions 11-20)

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11. A 38-year old man was brought to the emergency room due to profuse bleeding from chest stab wound. Assessments of his vital signs are follows: BP is 80/40 mmHg, PR is 110 bpm, and RR is 28. The nurse expects which of the following potential problems?

a) cardiogenic shock
b) hypovolemic shock
c) neurogenic shock
d) septic shock

12. A 60-year old clients report to the nurse that he has rash on his back and right flank. The nurse observes elevated round blister-like lesions that are filled with clear fluid. When documenting the findings, what medical term should the nurse use to describe these lesions?

13. When caring for a client in restraints, which of the following is not appropriate nursing action?

a) ensure that written consent for restraint application has been secured from relatives
b) apply soft restraints
c) secure restraints on the side rails
d) check client and area of restraints application every 15-20 minutes

14. Which of the following is incorrect statement about incident reports?

a) it is a tool used as means of identifying and improving care
b) the report form should be placed in the client's record
c) it is not a substitute for complete entry in the client's record regarding the incident
d) it should be complete, accurate and factual

15. In which of the following situations does the nurse practice beneficence?

a) she reports child abuse to the local authority
b) she advocates for the client from the practitioner who practices drug abuse
c) she refers the abused woman to support group
d) she practices universal precaution when caring for clients

16. The nurse from obstetric department is floated to the emergency department. Who among these clients will the charge nurse appropriately assign to the nurse?

a) the client receiving blood transfusion
b) the client with acute asthmatic attack
c) the client who is confused and agitated
d) the client who has chest injury

17. The client has severe jaundice. Which of the following should the nurse not include when giving health teachings?

a) keep the environment warm
b) cut fingernails short and smoothen them
c) wash skin with water and mild soap
d) change clothing as necessary

18. Which of the following herbal medicines is used to relieved stress, boost energy, and provides digestive support?

a) feverfew
b) aloe vera
c) cranberry
d) ginseng

19. An 88-year old client complains, "I frequently wake-up at night." What advise would the nurse give to the client?

a) drink milk instead of coffee at bedtime
b) limit your fluid intake to 1 liter a day
c) avoid drinking too much fluid before bedtime
d) drink fluids only when you're thirsty

20. Who among these clients may be assigned by the RN to the CNA?

a) the client on blood transfusion started 2 hours ago, whose BP needs to be checked
b) the client who requires nasogastric tube feedings every 3 hours
c) the client whose bladder is distended and requires catheterization
d) the client with tracheostomy who requires suctioning as necessary


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NCLEX Preparation Course - Critical Thinking Exercises IV (Answers 1-10)

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Here are the Questions to NCLEX Preparation Course - Critical Thinking IV (1-10) -->

1) B
- the situation describes signs and symptoms of dehydration.
Normal serum sodium is 135-145 mEq/L
Normal BUN is 5-25 mg/dl

2) B
- tetenus immune globulin provides passive immunity. This is recommended if the client had not received tetanus immunization or when tetanus immunization history could not be determined.

3) D
- DIC - is body's response to overstimulation of clotting and articulating processes in response to injury or disease. In DIC, bleeding occurs due to depletion of platelets in the general circulation which is due to massive blood clotting (decreased fibrinogen, increased protime, increased PTT, decreased platelets).

4) A
- tetracycline and neomycin (an aminoglyceride) may cause respiratory depression. Penicillins and aminoglycerides when combined with muscle relaxants and anesthesia may also cause respiratory depression.

5) D
- hemophilia is a defect in clotting mechanism of blood. It is characterized by prolonged bleeding; therefore any form of trauma including injections should be avoided.

6) C
- this client is at risk for falls and is experiencing other-directed violence. The nurse has great responsibility in protecting the client from harm and in protecting other clients from harm, as well.

7) A
- postop client should be roomed-in with a client without infection. Age and gender should also be considered.

8) A
- the client with life-threatening problem like profuse bleeding should be given highest priority. Priority: ABC.

9) A
- STD's (sexually-transmitted diseases) like Chlamydia may cause sterility.

10) B
- the manifestations describe huntington's disease. Creutzfeldt-jacob's disease is a progressive disease of CNS characterized by spongiform degeneration of the gray matter of the brain. Multiple sclerosis is characterized by demyelination of the central nervous system. Parkinson's disease affects the EPS that leads to decreased dopamine production.


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Online Nursing Practice Test about Respiratory Diseases (21-28)

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Situation: Mr. Tan, a 40 year old with asthmatic attack is admitted in the medical ward.

21. Mr. Tan admits to the nurse that he takes the following medications. Which medication may cause asthma attack?

a) milk of magnesia
b) pepcid ( famotidine)
c) acetylsalicylic ( aspirin)
d) benadryl ( diphenhydramine)

22. Your finding in your assessment would include the following except:

a) ability to speak words without taking deep breath
b) tachycardia, cool and moist skin
c) air hunger and presence of wheezing sound
d) tachycardia, warm and moist skin

23. With your assessment which of these symptoms would you expect to develop late?

a) nasal flaring
b) lips pursed in an effort exhale
c) cyanosis
d) use of accessory muscles for breathing

24. Which has the least tendency to precipitate or trigger asthmatic attack?

a) air pollution
b) cold climate
c) sudden changes in climate
d) molds, house dust

25. The most comfortable position for him to assume during asthmatic attack is:

a) sitting
b) orthopneic
c) fowlers
d) supine

26. Which of the following breathing patterns shows that the patient with chronic asthma has improved respiratory status?

a) a rate of exhalation twice that of inhalation
b) a rate of inhalation twice that of exhalation
c) slow, shallow inhalation
d) slow, deep exhalation

27. Which finding below would indicate the most effective response to asthma medications?

a) the ability to participate in active sports for longer periods
b) cyanosis subsides
c) peak expiratory flow rate (PEFR) within normal limits
d) patient can breathe on his own without oxygen

28. The child with asthma, has elevated WBC and eosinophils. Which of the following should be included in the nursing care plan of the client?

a) provide a private room
b) room-in the child with another child with asthma
c) room-in the child with another child with chicken pox
d) room-in the child with another child with glomerulonephritis



ANSWERS AND RATIONALE

21) C
- Common Factors Triggering an Asthmatic Attack
1. Medications:
  • Aspirin and NSAID - can trigger allergic reaction, its anti-inflammatory effect decreases histamine secretion and mucus secretion causing pooling of thick mucus that obstructs the airway and triggers an asthmatic attack
  • beta blockers
  • cholinergic drugs - eye drops used in glaucoma (pilocarpine) and bladder contraction
  • chemicals - paint, solvents, rubber, plastic - avoid engaging in tasks that involves the use of these chemicals, avoid powder detergents

2. Air pollutants - instruct to close car window and use airconditioner

3. Sudden changes in temperature

4. Cold air - exercising in cold air

5. Allergens - feather, pollen, dust, molds, animal dander - keep away from pets, remove carpets and curtains, damp dusting, stay indoor when grass cutting and when pollen count is high, close window at night, avoid garage and basements, avoid feather pillow

6. Exercise - irregular exercise schedules and excessive physical exertion

7. stress

8. Strong odors

22) A
- common assessment findings in asthma include: wheezing, chest tightness, breathlessness, coughing, anxiety, apprehension, tachypnea and tachycardia.
Patients experiencing asthmatic attack can usually speak only one or two words between breaths because of severe dyspnea, anxiety, fatigue and apprehension.

23) C
- Signs and Symptoms of Asthma

Asthma is caused by inflammatory response in the lungs triggered by any of the above mentioned allergens. When a patient comes in contact with allergens. IgE is produced which stimulate the mast cells in the lungs to release inflammatory mediators in the lungs such as histamine, prostaglandins and leokotrienes. These substances cause the following pathologic changes in the lungs that cause the signs and symptoms of asthma:
  • bronchospasms which narrows airways causing wheezing, shortness of breath
  • increased mucus production which blocks airways and causes nonproductive cough
  • increased capillary permeability which causes edema of the airways decreasing area for gas exchange.
All these contribute to airway obstruction. In an effort to overcome the airway obstruction, the patient must exert much respiratory effort when breathing such as nasal flaring, pursed lip breathing and use of accessory muscles. Cyanosis is a late sign in asthma. It indicates impaired gas exchange and that the tissues are no longer receiving adequate oxygen supply. Auscultation reveals wheezing especially on expiration. The absence of wheezing is a dangerous sign that indicates that the small airways are too constricted to allow air to pass through.

24) B
- cold climate does not trigger asthmatic attack but it is the sudden changes in environmental temperature or sudden weather changes that does. However, exercising in cold weather usually trigger asthma.

25) B
- the ideal position for a patient with asthma is the orthopneic position in which the patient is in high fowler's position with the head and arms resting on the over bed table. This position promotes lung expansion and facilitates breathing

26) A

27) C
- PERF and Drugs used in Asthma

PERF refers to amount of air inspired. If the PERF is below the amount of air inspired, it means that air is trapped in the alveoli and bronchioles because of bronchial spasms and blockage by accumulated secretions, this prevents proper exchange of oxygen and carbon dioxide and leads to hypoxia and acidosis. Peak flow meters measures PERF. If medication used to relax and dilate bronchioles is effective, effective gas exchange will be manifested by an improved PERF because air will be able to freely enter and leave the lungs and normal gas exchange will be able to take place.

Drugs used in asthma include:

1. Bronchodilators - relieve bronchospasms
  • epinephrine/ephedrine/terbutaline
  • theophylline
  • albuterol (ventalin and proventil)
  • isoproterenol (isuprel)/metaproterenol (metaprel and alupent)
  • give the inhaled bronchodilator before the ant-inflammatory steroids
2. Anti-inflammatory - prevent histamine and decrease mucus
  • hydrocortisone/dexamethasone/beclomethasone
3. Prophylactic therapy to prevent future attacks
  • cromolyn sodium (intal)
28) A
- elevated WBC indicates that the child is experiencing infection. Therefore, the child should not be roomed-in with another child. Provide a private room for this child.


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Test Prep for Nursing Exam about Obstetric Nursing (16-20)

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16. A pregnant woman is being given magnesium sulfate per slow IV drip. This medication is intended to control

a) embolism
b) seizures
c) bleeding
d) uterine contractions

17. Abnormal fetal lie and position were noted. Which of the following procedures does the nurse expect to be arranged first, before external rotation (version) is done?

a) amniocentesis
b) ultrasound
c) fetal heart rate monitoring
d) x-ray

18. A client is 32 weeks pregnant. She experiences cord prolapse and is in active labor. Which of the following should be the most immediate action by the nurse?

a) push the cord back into the uterus with a gloved hand
b) cover cord with sterile dry gauze
c) place the client in knee-chest position
d) prepare the client for immediate vaginal delivery

19. Who among these pregnant clients is at risk for bleeding?

a) the client who has history of preterm delivery
b) the client who has twins in her present pregnancy
c) the client who is 18 years of age and is pregnant for the first time
d) the client who is pregnant for the third time

20. Which of the following health teachings should be included for a mother who complains of soreness of nipples because of breastfeeding her infant?

a) wash your breast with soap and water
b) stop breatfeeding for few days
c) apply lanolin cream on the nipple
d) avoid wearing bra until soreness of nipples disappears



ANSWERS AND RATIONALE

16) B
- magnesium sulfate is a CNS depressant. It is given to a client with PIH to prevent seizure.

17) C
- fetal heart rate monitoring should be done before external version procedure is done to correct breech presentation to cephalic presentation. This is to ensure that the fetus can tolerate the stress of the procedure.

18) C
- knee-chest position relieves pressure from prolapsed cord. The cord should not be pushed back into the uterus to prevent trauma. The cord should be covered with sterile moist gauze to prevent necrosis. Preparing the client for immediate delivery will be the next nursing action after positioning the client.

19) B
- the client with multiple gestation is prone to bleeding, due to over distention of the uterus.

20) C
- lanolin cream soothes the sore nipples.
Choice A - wash the breast with water only; no soap
Choice B - there is no need to stop breastfeeding
Choice D- wearing supportive bra minimizes the discomfort


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NCLEX Secrets about Musculoskeletal Injuries (26-30)

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NCLEX Secrets about Musculoskeletal Injuries

26. Which among these clients is at highest risk for developing low back pain?

a) the man working with a drill hammer
b) the man delivering mails in the building
c) the salesman selling truck tires
d) the man washing windows of a building

27. The client had been diagnosed to have fracture of the tibia after a motorcycle accident. Few hours after, he complains of pain distal to the injury, with numbness and tingling sensation. The nurse notes pallor and coolness of the extremity with absent distal pulse. What complication of fracture does the nurse identify in this client?

28. A man with cast will start to walk with crutches. What should the nurse check first?

a) lying and sitting blood pressure
b) pulse rate
c) temperature
d) respiratory rate

29. Which of the following is the primary reason for splinting the hands and wrists of client with rheumatoid arthritis?

a) to improve the strength of the hands and wrists
b) to prevent contractures
c) to relieve muscle spasm
d) to relieve pain

30. Which of the following factors should concern the nurse most in a client who had undergone total hip replacement?

a) the client has a small dog and a cat at home
b) the client goes for a walk in the park each morning
c) the client showers instead of having tub bath
d) the client uses raised toilet seat





NCLEX Secrets about Musculoskeletal Injuries:
ANSWERS AND RATIONALE

26) A
- dealing with drill hammer puts strain at the back more than the other jobs mentioned.

27) Compartment Syndrome
- compression and edema of the content of the compartment (blood vessels, nerves, and muscles) leads to five p's - pain, pallor, pulselessness, paresthesia, paralysis.

28) A
- BP should be checked first before starting to ambulate to assess for potential postural hypotension.

29) B
- splinting of hands and wrists of the client with rheumatoid arthritis is done primarily to prevent contractures.

30) A
- bending and stooping like taking care of a small dog and a cat, may cause dislodgement of the hip prosthesis.




Go to the next page ---> NCLEX Secrets about Musculoskeletal Injuries (31-35)  

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Online Nursing Practice Test about Renal Disorders (21-25)

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21. Which of the following should the nurse include in the nursing care plan of the client who is diagnosed to have renal failure, whose BUN is 32 mg/dl, serum creatinine is 4 mg/dl, hematocrit is 38%. He is complaining of fatigue and edema.

a) low protein diet and fluid restriction
b) high protein diet and fluid restriction
c) low protein diet and increase in fiber
d) high protein diet and potassium restriction

22. The client in end-stage of renal failure had undergone kidney transplant. Which of the following assessment findings indicate kidney transplant rejection?

a) increased urinary output, BUN = 15 mg/dL
b) HCT = 50%, Hgb = 17 g/dl
c) decreased urinary output, sudden weight gain
d) decreased urinary output, sudden weight loss

23. Which of the following assessment findings indicates that pyridium is effective in a client with urinary tract infection?

a) the client's urine culture yields negative result
b) the client is able to void every 2 to 3 hours
c) the client verbalizes that she is relieved from pain
d) the client is able to void 30-60 ml/hour

24. Which of the following anti-hypertensive medications is contraindicated for clients with renal insufficiency?

a) beta-adrenergic blockers
b) calcium-channel blockers
c) direct-acting vasodilators
d) angiotensin-converting enzyme inhibitors

25. The client has been diagnosed to have glomerulonephritis. What should the nurse observe in the urine?

a) blood
b) pus
c) white blood cells
d) glucose



ANSWERS AND RATIONALE

21) A
- the diet for a client with elevated BUN and serum creatine should be low protein, to reduce urea and nitrogenous waste products. For edema, fluid restriction should be implemented.

22) C
- kidney transplant rejection is manifested by failure of renal functions like decreased urinary output and water retention, as manifested by weight gain.

23) C
- pyridium is a urinary analgesic. It will normally cause red-orange discoloration of the urine.

24) D
- ACE inhibitors may cause hyperkalemia. It should be used with great caution if it is prescribed for a client with renal insufficiency.

25) A
- glomerulonephritis causes gross hematuria. The urine appears dark, smoky, cola-colored, or red-brown.


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Test Prep for Nursing Exam about Pediatric Nursing (16-20)

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16. Which of the following assessment findings is normal in a 6-month old infant?

a) is able to hold his bottle
b) is able to sit unsupported
c) is able to use a spoon
d) is able to creep

17. After receiving endorsement, which of the following clients should the nurse see first?

a) a 2-day old infant, lying quietly, is alert, with a heart rate of 135 bpm
b) a day-old infant, who is crying, with anterior fontanel bulging
c) a 12-hour old infant held by the mother with respiration of 45 cpm
d) a 3-hour old infant, whose temperature is 36.7 C, with irregular abdominal breathing; respiratory rate of 50 cpm

18. Which of the following statements when made by the father of a 2-month old infant indicates that he understands the normal growth and development of the child?

a) I expect my baby to hold his bottle
b) I expect my baby to smile back at me
c) I expect my baby to have complete head control
d) I expect my baby to roll over

19. Which of the following toys is most appropriate for a 2 1/2-year old child?

a) squeeze toys
b) stacking blocks
c) colored mobiles
d) video games

20. Which of the following findings is expected in a 6-month old infant?

a) turns from side to back
b) turns from back to side
c) turns from side to stomach
d) turns from side to side



ANSWERS AND RATIONALE

16) A
- a six-month old infant is able to hold his bottle
Choice B - describes an 8-month old
Choice C - describes a 10-12 month old
Choice D - describes a 9-month old

17) B
- the infant with bulging fontanel is experiencing increased intracranial pressure. Choices A, C, and D indicate stable conditions.

18) B
- a two month old infant is capable of "social smile".

19) B
- stacking blocks are appropriate for a toddler. Squeeze toys and colored mobiles are appropriate for an infant. Video games are appropriate for a school age child.

20) D
- a 6-month old infant can completely roll over (side to side). a 2-month old can turn from side to back. A 4-month old can turn from back to side.


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NCLEX Preparation Course - Critical Thinking Exercises IV (Questions 1-10)

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Here are the Answers to NCLEX Preparation Course - Critical Thinking IV (1-10) -->

1. The client is complaining of confusion, tachycardia, serum sodium level is 150 mEq/L, BUN is 30 mg/dl. Which of the following problems should the nurse watch for?

a) fluid volume excess
b) fluid volume deficit
c) ineffective tissue perfusion
d) risk for injury

2. The client has severe wound from a vehicular accident. His tetanus immunization status is unknown. Which of the following is the most appropriate nursing action?

a) do not give tetanus immunization
b) give tetanus immune globulin
c) give tetanus toxoid
d) give tetanus toxoid immediately, then etanus globulin after one week

3. Which of the following laboratory findings support the diagnosis of disseminated intravascular coagulopathy (DIC)?

a) elevated factor assays (II, V, and VII)
b) increased platelet count
c) elevated RBC, WBC, platelets
d) prolonged prothrombin time and partial thromboplastin time

4. Which of the following drugs are contraindicated in a client with multiple sclerosis?

a) tetracycline and neomycin
b) penicillins and cephalosporins
c) aminoglycerides and vancomycins
d) quinolones and cephalosphorins

5. Which of the following actions by the registered nurse needs intervention by the charge nurse?

a) the nurse applies compression stockings to a client with leg edema
b) the nurse applies ice pack over the abdomen of the client with appendicitis
c) the nurse serves the bedside commode to the client with myocardial infarction
d) the nurse is about to five IM injection to a client with hemophilia

6. Who among these patients should the nurse see first after signing in?

a) a depressed client curled in a fetal position at a corner in his room
b) a 16-year old girl with anorexia nervosa sitting quietly in her bed
c) a manic patient standing on the chair and threatening to beat or slap another patient with post traumatic stress disorder
d) a 24-year old patient with obsessive-compulsive disorder who keeps on putting on and off his socks

7. Who among these clients should be roomed-in with a 6-year old boy for splenectomy?

a) the 5-year old boy who had gastric surgery
b) the 7-year old boy with asthma and streptococcal infection
c) the 6-year old boy with pneumonia
d) the 6-year old boy with amoebiasis

8. The nurse witnessed a vehicular accident on her way home from work. Who among these victims should the nurse attend to first?

a) a 25-year old man with fracture on the leg and bleeding profusely
b) a 4-year old child with fixed and dilated pupil
c) an 80-year old client with fracture on his arm and had petechiae on his chest
d) a 40-year old client who is showing panic anxiety

9. Which of the following is a common potential complication of Chlamydia?

a) sterility
b) peritonitis
c) endocarditis
d) pericarditis

10. Which of the following diseases is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movement and dementia

a) multiple sclerosis
b) huntington's disease
c) parkinson's disease
d) creutzfeldt-jacob's disease


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NCLEX Preparation Course - Critical Thinking Exercises III (Answers 21-30)

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Here are the Questions to NCLEX Preparation Course - Critical Thinking III (21-30) -->

21) A
- shigellosis is a type of gastroenteritis. The microorganism is transmitted through oro-fecal route.

22) B
- marfan syndrome is characterized by tall, thin skeleton. The arms and legs are disproportionately long.

23) A
- blood loss during surgery and decreased aldosterone secretion that leads to sodium and water loss, require fluid and electrolyte replacement. This is to prevent hypovolemic shock.

24) A
- absence of drainage from the ileostomy for six hours indicates obstruction. This situation should be given highest priority. Ileostomy normally has continuous drainage of watery feces.

25) B
- sexual activity after protastectomy is resumed when healing is complete and comfort is reassured and usually this is within 2-3 weeks after discharge.

26) C
- the statement of the client indicates suicidal ideation. This should be given highest priority (Safety is a priority).

27) A
- raising the knee-gatch causes pressure at the popliteal area. This causes venous stasis. Therefore, avoid raising knee-gatch to prevent thrombophlebitis.

28) D
- the charge nurse should call the security. The security will arrange for the nurse's transport home. Do not allow the nurse to drive when he is under the influence of alcohol. It is not safe to allow the nurse who smells alcohol to continue caring for patients.

29) C
- Bell's palsy is paralysis of the facial nerves. Cold application will cause hypersensitivity of the side of the face.

30) B
- potassium level is high which may cause dysrhythmias/cardiac arrest. Cardiac monitoring should be done.


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NCLEX Secrets - Neurology Board Review (26-30)

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NCLEX Secrets - Neurology Board Review

26. The client had been diagnosed to have Parkinson's disease. He is receiving levodopa. Which of the following health teachings should be included by the nurse?

a) avoid over exposure to sunlight
b) avoid taking pyridoxine and fortified cereals
c) increase fluid intake
d) discontinue the drug if it causes reddish brown discoloration of urine

27. The client is diagnosed to have amyotrophic lateral sclerosis. Which of the following signs and symptoms should the nurse observe?

a) resting tremors, rigidity, shuffling gait
b) muscle atrophy, spasticity, difficulty breathing
c) intentional tremors, diplopia, scanning speech
d) mask-like face, ascending paralysis, paresthesia

28. The client had been diagnosed to have chronic hypertension. His LDL levels are high while HDL levels are low. Which information does the nurse give to the client about factors that may increase HDL levels?

a) HDL levels may be increased by physical activity and estrogen
b) HDL levels may be increased by antihyperlipidemic agents
c) HDL levels may be increased by low cholesterol diet
d) HDL levels may be increased by bed rest

29. The client has been diagnosed to have Guillain-Barre Syndrome (GBS). Which of the following should the nurse include in the nursing care plan of the client?

a) check ability to hear
b) check bladder distention
c) check blood pressure every 2 hours
d) check deep tendon reflexes every shift

30. Who among these hypertensive clients should the nurse follow-up first?

a) the white American client with BP of 160/100 mmHg, which went down to 140/90 mmHg one hour after taking Nifedipine.
b) the black American with BP of 161/98 who took anti-hypertensive medication twice but no progress noted
c) the native American client with BP ranging between 140/90 to 160/100 for the last 3 days
d) the Asian American client with BP of 116/84 and claims that he had been taking anti-hypertensive medication since 2 years ago





NCLEX Secrets - Neurology Board Review:
ANSWERS AND RATIONALE

26) B
- pyridoxine blocks effect of levodopa. Reddish brown discoloration of urine is a harmless side effect of levodopa.

27) B
- amyotrophic lateral sclerosis is a degenerative motor neuron disorder that affects muscles.
Choice A describes Parkinson's disorder.
Choice C describes multiple sclerosis
Choice D describes guillain-barre's syndrome

28) A
- regular pattern of activity/exercise and estrogen may increase HDL levels (good cholesterol). High density lipoprotein is necessary to prevent atherosclerosis.

29) B
- GBS is an acute infectious polyneuritis of the cranial and peripheral nerves. It involves destruction of myelin sheath. It is usually preceded by a mild upper respiratory infection or gastroenteritis. It is characterized by ascending paralysis. Poor bladder tone is a characteristic manifestation.

30) B
- the client might go to hypertensive crisis since he is not responding to medications. This increases risk to cerebrovascular accident (CVA). Therefore, this client should be given highest priority by the nurse.


Go to the next page ---> NCLEX Secrets - Neurology Board Review (31-35)  

Or Go back to NCLEX Secrets - Neurology Board Review (1-5) to start the test from the beginning.


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Online Nursing Practice Test about Respiratory Diseases (29-35)

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NCLEX E-Book ($4)


29. The client had undergone thoracentesis. Which of the following is a correct action by the LVN (Licensed Vocational Nurse) immediately after the procedure?

a) she turns the client towards the affected side
b) she turns the client towards the unaffected side
c) she places the client in a supine position
d) she places the client in semi-fowler's position

30. The client is diagnosed to have advanced chronic obstructive pulmonary disease (COPD). Which of the following nursing action would best promote adequate gas exchange?

a) administering sedative as prescribed
b) placing the client in upright position
c) using high-flow venturi mask to deliver oxygen
d) encourage client to drink 6 glasses of fluid daily

31. A 48-year old man with tuberculosis is taking INH with pyridoxine (Vit. B6). The client asks why it is necessary for him to take pyridoxine. Which of the following is the most appropriate response by the nurse?

a) it increases INH absorption
b) it prevents INH-associated neuritis
c) it decreases toxicity of INH
d) it increases the effectiveness of INH

32. The child with croup is in a mist tent. Which of the following toys will be appropriate for the child?

a) stuffed toys
b) drawing book
c) plastic ball
d) coloring book

33. The client had been subjected to thoracentesis without written consent. What offense are the health care providers liable for?

a) assault
b) battery
c) manslaughter
d) invasion of privacy

34. The client with acute asthmatic attack is receiving Theophylline (Aminophylline) drip. Which of the following nursing actions should be included in the nursing care plan of the client?

a) note for decreased urine output
b) observe for elevated temperature
c) be alert for decreased BP
d) monitor for decreased pulse rate

35. Which of the following is the best position for a client who had undergone lobectomy?

a) side-lying position
b) supine position
c) sitting upright, leaning forward position
d) semi-fowler's position



ANSWERS AND RATIONALE

29) B
- after thoracentesis, turn the client towards unaffected side to prevent leakage of fluid into the thoracic cavity.

30) B
- upright position enhances adequate ventilation. The client with COPD is best placed in upright, leaning forward position.

31) B
- the common side effect of INH is peripheral neuritis. Vitamin B6 prevents this side effect.

32) C
- plastic ball does not absorb moisture within the mist tent. Therefore, it is the most appropriate toy for the child. Toys that may absorb moisture should be avoided because dampness may lower the child's resistance to infection.

33) B
- battery is intentional touching a person's body part without his consent.

34) C
- aminophylline causes diuresis, and therefore hypotension may occur.

35) D
- semi-fowler's position will promote maximum lung expansion. Therefore, this is the best position after a lung surgery like lobectomy.


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NCLEX Review about Cardiac Nursing (16-20)

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NCLEX Review about Cardiac Nursing

16. Which of the following signs and symptoms indicate pacemaker failure?

a) excessive thirst
b) prolonged hiccups
c) flushing of the skin
d) increased urine output

17. The client is diagnosed to have acute myocardial infarction. He has a nursing diagnosis of decreased cardiac output. This is secondary to

a) chest pain
b) circulatory overload
c) electrolytes imbalance
d) ventricular dysrhythmias

18. Which of the following physician's order should the nurse question when preparing a client who will undergo artery bypass graft within an hour?

a) potassium chloride per slow IV drip
b) calcium channel blocker
c) digoxin
d) prophylactic antibiotic

19. The client has been diagnosed to have right-sided congestive heart failure (RSCHF). Which of the following signs and symptoms does the nurse expect to observe in the client?

a) shortness of breath
b) ascites
c) rales in the lung apices
d) pink-tinged, frothy sputum

20. The client with cardiac disorder experiences hypokalemia. Which of the following ECG changes would the client have?

a) elevated ST segment
b) presence of U-wave
c) tall T-wave
d) prolonged QRS complex




NCLEX Review about Cardiac Nursing
ANSWERS AND RATIONALE

16) B
- prolonged hiccups indicate pacemaker failure. Other signs and symptoms of pacemaker failure are dysrhythmias, dizziness, faintness, chest pain, shortness of breath, increase or decrease in apical rate.

17) D
- ventricular dysrhythmias are the primary causes of decreased cardiac output with myocardial infarction.

18) C
- digoxin increases force of cardiac contractility and therefore it increases cardiac workload.

19) B
- RSCHF is characterized by venous backup, like ascites. Choices A, C, and D are manifestations of a client with Left-sided CHF.

20) B
- hypokalemia is characterized by presence of U-wave, depressed ST segment, and short T-wave.




Go to  the next page ---> NCLEX Review about Cardiac Nursing (21-25)  

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