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

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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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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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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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