NCLEX Pharmacology Questions (86-90)

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86. A client with myasthenia gravis is admitted to the hospital, and the nursing history reveals that the client is taking pyridostigmine (Mestinon). The nurse assesses the client for side effects of the medication and asks the client about the presence of:

a) mouth ulcers
b) muscle cramps
c) feelings of depression
d) unexplained weight gain

87. A nurse is performing an assessment on a client with a diagnosis of chronic angina pectoris who is receiving sotalol (Betapace) 80 mg orally daily. Which assessment finding indicates that the client is experiencing a side effect of the medication?

a) dry mouth
b) palpitations
c) diaphoresis
d) difficulty swallowing

88. A nurse is caring for a client who had an allogenic liver transplant and is receiving tacrolimus (Prograf) daily. Which finding indicates to the nurse that the client is experiencing an adverse reaction to the medication?

a) photophobia
b) hypotension
c) profuse sweating
d) decrease in urine output

89. A nurse is caring for a client who is receiving cyclosporine (Gengraf). Which of the following indicates to the nurse that the client is experiencing an adverse reaction to the medication?

a) acne
b) sweating
c) joint pain
d) hyperkalemia

90. A nurse is caring for a client with hypertension receiving torsemide (Demadex) 5 mg orally daily. Which of the following would indicate to the nurse that the client might be experiencing an adverse reaction related to the medication?

a) a chloride level of 98mEq/L
b) a sodium level of 135 mEq/L
c) a potassium level of 3.1 mEq/L
d) a blood urea nitrogen (BUN) of 15 mg/dL






NCLEX Pharmacology Questions
Answers and Rationale

86) B
- Mestinon is an acetylcholinesterase inhibitor. Muscle cramps and small muscle contractions are side effects and occur as a result of overstimulation of neuromuscular receptors. Options A, C, and D are not associated with this medication.

87) B
- Sotalol is a beta-adrenergic blocking agent. Side effects include bradycardia, palpitations, an irregular heartbeat, difficulty breathing, signs of congestive heart failure, and cold hands and feet. Gastrointestinal disturbances, anxiety and nervousness, and unusual tiredness and weakness can also occur. Options A, C, and D are not side effects of this medication.

88) D
- Tacrolimus is an immunosuppressant medication used in the prophylaxis of organ rejection in clients receiving allogenic liver transplants. Frequent side effects include headache, tremor, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting, abdominal pain, and hypertension. Adverse reactions and toxic effects include nephrotoxicity and pleural effusion. Nephrotoxicity is characterized by an increasing serum creatinine level and a decrease in urine output.

89) D
- Cyclosporine is an immunosuppressant medication used in the prophylaxis of organ rejection. Adverse effects include nephrotoxicity, infection, hypertension, tremor, and hirsutism. Additionally, neurotoxicity, gastrointestinal effects, hyperkalemia, and hyperglycemia can occur. Options A, B, and C are not associated with this medication.

90) C
- Torsemide (Demadex) is a loop diuretic. The medication can produce acute, profound water loss, volume and electrolyte depletion, dehydration, decreased blood volume, and circulatory collapse. Option 3 is the only option that indicates an electrolyte depletion because the normal potassium level is 3.5 to 5.1 mEq/L. The normal sodium level is 135 to 145 mEq/L. The normal chloride level is 98 to 107 mEq/L. The normal blood BUN is 5 to 20 mg/dL.



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Nursing Leadership Programs (46-50)

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46. A nurse is working in the emergency department of a small local hospital when a client with multiple gunshot wounds arrives by ambulance. Which of the following actions by the nurse is contraindicated in the handling legal evidence?

a) initiate a chain of custody log
b) give clothing and wallet to the family
c) cut clothing along seams, avoiding bullet holes
d) place personal belongings in a labeled, sealed paper bag

47. A registered nurse (RN) is orienting a nursing assistant to the clinical nursing unit. The RN would intervene if the nursing assistant did which of the following during a routine handwashing procedure?

a) kept hands lower than elbows
b) dried from forearm down to fingers
c) washed continuously for 10 to 15 seconds
d) used 3 to 5 ml of soap from the dispenser

48. A registered nurse (RN) on the night shift assists a staff member in completing an incident report for a client who was found sitting on the floor. Following completion of the report, the RN intervenes if the staff member prepares to:

a) notify the nursing supervisor
b) ask the secretary to telephone the physician
c) document in the nurse's notes that an incident report was filed
d) forward incident report to the Continuous Quality Improvement Department

49. A physician visiting a client on the nursing unit is paged and notified that the monthly physician's breakfast meeting is about to start. The physician states to the nurse : "I'm in a hurry. Can you write an order t decrease the atenolol (Tenormin) to 25mg daily?" Which of the following is the appropriate nursing action?

a) write the order
b) call the nursing supervisor to write the order
c) inform the client of the change of medication
d) ask the physician to return to the nursing unit to write the order

50. A registered nurse suspects that a colleague is substance impaired and notes signs of alcohol intoxication in the colleague. The Nurse Practice Act requires the registered nurse do which of the following?

a) talk with the colleague
b) call the impaired nurse organization
c) report the information to a nursing supervisor
d) ask the colleague to go to the nurse's lounge to sleep for a while






Nursing Leadership Programs
Answers and Rationale

46) D

- Basic rules for handling evidence include limiting the number of people with access to the evidence, initiating a chain of custody log to track handling and movement of evidence, and carefully removing of clothing to avoid destroying evidence. This usually includes cutting clothes along seams, while avoiding areas where there are obvious holes or tears. Potential evidence is never released to the family to take home.

47) B

- Proper handwashing procedure involves wetting the hands and wrists and keeping the hands lower than the forearms so that water flows toward the fingertips. The nurse uses 3 to 5 mL of soap and scrubs for 10 to 15 seconds, using rubbing and circular motions. The hands are rinsed and then dried, moving from the fingers to the forearms. The paper towel is then discarded, and a second one is used to turn off the faucet to avoid hand contamination.

48) C

- Nurses are advised not to document the filing of an incident report in the nurses' notes for legal reasons. Incident reports inform the facility's administration of the incident so that risk management personnel can consider changes that might prevent similar occurrences in the future. Incident reports also alert the facility's insurance company to a potential claim and the need for further investigation. Options A, B, and D are accurate interventions.

49) D

- Nurses are encouraged not to accept verbal orders from the physician because of the risks of error. The only exception to this may be in an emergency situation, and then the nurse must follow agency policy and procedure. Although the client will be informed of the change in the treatment plan, this is not the appropriate action at this time. The physician needs to write the new order. It is inappropriate to ask another individual other than the physician to write the order.

50) C

- Nurse Practice Acts require reporting the suspicion of impaired nurses. The Board of Nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the Board of Nursing. Confronting the colleague may cause conflict. Asking the colleague to go to the nurses' lounge to sleep for awhile does not safeguard clients.




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Nursing Leadership NCLEX Questions (41-45)

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41. When assessing the client with the vest restraint (security device) at the beginning of day shift, which observation by the charge nurse would indicate that the nurse who placed the vest restraint on the client failed to follow safety guidelines?

a) a hitch was used to secure the restraint
b) the call light was placed within reach of the client
c) the restraint was applied tightly across the client's chest
d) the client's record indicates that the restraint will be released every 2 hours

42. A male client who is admitted to the hospital for an unrelated medical problem is diagnosed with urethritis caused by chlamydial infection. The nursing assistant assigned to the client asks the nurse what measures are necessary to prevent contraction of the infection during care. The nurse tells the nursing assistant that:

a) enteric precautions should be instituted for the client
b) gloves and mask should be used when the in client's room
c) contact isolation should be initiated, because the diseases is highly contagious
d) standard precautions are sufficient, because the disease is transmitted sexually

43. A nursing assistant is caring for an older male client with cystits who has an indwelling urinary catheter. The registered nurse provides directions regarding urinary catheter care and ensures that the nursing assistant:

a) loops the tubing under the client's leg
b) places the tubing below the client's knee
c) uses soap and water to cleanse the perineal area
d) keeps the drainage bag above the level of the bladder

44. A nurse is planning care for a client with acute glomerulonephritis. The nurse instructs the nursing assistant to do which of the following in the care of the client?

a) ambulate the client frequently
b) monitor the temperature every 2 hours
c) encourage a diet that is high in protein
d) remove the water pitcher from the bedside

45. A nurse watches a second nurse perform hemodialysis on a client. The second nurse is drinking coffee and eating doughnut next to the hemodialysis machine while talking with the client about the client's week. The first nurse should:

a) get a cup of coffee and join in on the conversation
b) determine whether or not the client would like a cup of coffee
c) admire the therapeutic relationship the second nurse has with the client
d) ask the second nurse to refrain from eating and drinking in the client area





Nursing Leadership NCLEX Questions:
Answers and Rationale

41) C

- A vest restraint should never be applied tightly because it could impair respirations. A hitch knot may be used on the client because it can easily be released in an emergency. The call light must always be within the client's reach in case the client needs assistance. The restraint needs to be released every 2 hours (or per agency policy) to provide movement.

42) D

- Chlamydia is a sexually transmitted disease. Caregivers cannot acquire the disease during administration of care, and standard precautions are the only measure that needs to be used.

43) C

- Proper care of an indwelling urinary catheter is especially important to prevent prolonged infection or reinfection in the client with cystitis. The perineal area is cleansed thoroughly using mild soap and water at least twice a day and following a bowel movement. The drainage bag is kept below the level of the bladder to prevent urine from being trapped in the bladder, and, for the same reason, the drainage tubing is not placed or looped under the client's leg. The tubing must drain freely at all times.

44) D

- A client with acute glomerulonephritis commonly experiences fluid volume excess and fatigue. Interventions include fluid restriction as well as monitoring weight and intake and output. The client may be placed on bed rest or at least encouraged to rest, because a direct correlation exists between proteinuria, hematuria, edema, and increased activity levels. The diet is high in calories but low in protein. It is unnecessary to monitor the temperature as frequently as every 2 hours.

45) D

- A potential complication of hemodialysis is the acquisition of dialysis-associated hepatitis B. This is a concern for clients (who may carry the virus), client families (at risk from contact with the client and with environmental surfaces), and staff (who may acquire the virus from contact with the client's blood). This risk is minimized by the use of standard precautions, appropriate handwashing and sterilization procedures, and the prohibition of eating, drinking, or other hand-to-mouth activity in the hemodialysis unit. The first nurse should ask the second nurse to stop eating and drinking in the client area.



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Nursing Leadership NCLEX Questions (36-40)

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36. A registered nurse is a preceptor for a new nursing graduate an is describing critical paths and variance analysis to the new nursing graduate. The registered nurse instructs the new nursing graduate that a variance analysis is performed on all clients:

a) continuously
b) daily during hospitalization
c) every third day of hospitalization
d) every other day of hospitalization

37. When a nurse manager makes a decisions regarding the management of the nursing unit without input from the staff, the type of leadership style that the nurse manager is demonstrating is:

a) autocratic
b) situational
c) democratic
d) laissez-faire

38. A charge nurse knows that drug and alcohol use by nurses is a reason for the increasing numbers of disciplinary cares by the Board of Nursing. The charge nurse understands that when dealing with a nurse with such an illness, it is most important to assess the impaired nurse to determine:

a) the magnitude of drug diversion over time
b) if falsification of clients records occurred
c) the types of illegal activities related to the abuse
d) the physiological impact of the illness on practice

39. A nurse manager is planning to implement a change in the method of the documentation system for the nursing unit. Many problems have occurred as a result of the present documentation system, and the nurse manager determines that a change is required. The initial step in the process of change for the nurse manager is which of the following?

a) plan strategies to implement the change
b) set goals and priorities regarding the change process
c) identify the inefficiency that needs improvement or correction
d) identify potential solutions and strategies for the change process

40. A nurse receives a telephone call from the emergency department and is told that a child with a diagnosis of tonic-clonic seizures will be admitted to the pediatric unit. The nurse prepares for the admission of the child and instructs assistant to place which items at the bedside?

a) a tracheostomy set and oxygen
b) suction apparatus and an airway
c) an endotracheal tube and an airway
d) an emergency cart and laryngoscope








Nursing Leadership NCLEX Questions
Answers and Rationale

36) A

- Variance analysis occurs continually as the case manager and other caregivers monitor client outcomes against critical paths. The goal of critical paths is to anticipate and recognize negative variance early so that appropriate action can be taken. A negative variance occurs when untoward events preclude a timely discharge and the length of stay is longer than planned for a client on a specific critical path. Options B, C and D are incorrect.

37) A

- The autocratic style of leadership is task oriented and directive. The leader uses his or her power and position in an authoritarian manner to set and implement organizational goals. Decisions are made without input from the staff. Democratic styles best empower staff toward excellence because this style of leadership allows nurses to provide input regarding the decision-making process and an opportunity to grow professionally. The situational leadership style utilizes a style depending on the situation and events. The laissez-faire style allows staff to work without assistance, direction, or supervision.

38) D

- A nurse must be able to function at a level that does not affect the ability to provide safe, quality care. The highest priority is to determine how the illness affects the nurse's ability to practice. The other options will be addressed if an investigation is carried out.

39) C

- When beginning the change process, the nurse should identify and define the problem that needs improvement or correction. This important first step can prevent many future problems, because, if the problem is not correctly identified, a plan for change may be aimed at the wrong problem. This is followed by goal setting, prioritizing, and identifying potential solutions and strategies to implement the change.

40) B

- Tonic-clonic seizures cause tightening of all body muscles followed by tremors. Obstructed airway and increased oral secretions are the major complications during and following a seizure. Suction is helpful to prevent choking and cyanosis. Options A and C are incorrect because inserting an endotracheal tube or a tracheostomy is not done. It is not necessary to have an emergency cart (which contains a laryngoscope) at the bedside, but a cart should be available in the treatment room or on the nursing unit.


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Nursing Leadership NCLEX Questions (31-35)

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31. Based upon a request made by the client's spouse and children, a physician asks a nurse to discontinue the feeding tube in a client who is in chronic debilitated and comatose state. The nurse understands the legal basis for carrying out the order and first checks the client's record for documentation of:

a) a court approval to discontinue the treatment
b) approval by the institutional Ethics Committee
c) a written order by the physician to remove the tube
d) authorization by the family to discontinue the treatment

32. A nurse plans to carry out a multidisciplinary research project on the effects of immobility on client's stress levels. Of the following statements, which principle is most important when planning this project?

a)  any client has the right to refuse to participate in research studies
b) collaboration with other disciplines is essential to the successful practice of nursing
c) the cooperation of the physicians on staff must be ensured in order for the project to succeed
d) the corporate nurse executive should be consulted, because the project will take nursing time

33. A nurse manager has identified a problem on the nursing unit and holds unit meetings for all shifts. The nurse manager presents an analysis of the problem and proposals for actions to team members and invites the team members to comment and provide input. Which style of leadership is the nurse manager specifically employing?

a)  situational
b) laissez-faire
c) participative
d) authoritarian

34. A charge nurse observes that a staff nurse is not able to meet client needs in a reasonable time frame, does not problem-solve situations, and does not prioritize nursing care. The charge nurse has the responsibility to:

a)  supervise the staff nurse more closely so that tasks are completed
b) ask other staff members to help the staff nurse get the work done
c) provide support and identify the underlying cause of the staff nurse's problem
d) report the staff nurse to the supervisor so that something is done to resolve the problem


35. A registered nurse is preceptor for a new nursing graduate and is observing the new nursing graduate organize the client assignment and daily tasks. The registered nurse intervenes if the new nursing graduate does which of the following?

a) provide time for unexpected tasks
b) lists the supplies needed for a task
c) prioritizes client needs and daily tasks
d) plans to document task completion at the end of the day





Nursing Leadership NCLEX Questions
Answers and Rationale

31) D

- The family or a legal guardian can make treatment decisions for the client who is unable to do so. Once the decision is made, the physician writes the order. Generally, the family makes decisions in collaboration with physicians, other health care workers, and other trusted advisors. Although a written order by the physician is necessary, the nurse first checks for documentation of the family's request. Unless special circumstances exist, a court order is not necessary. Although some health care agencies may require reviewing such requests via the Ethics Committee, this is not the nurse's first action.

32) A

- The proposed project is research and includes human subjects. Although options B, C, and D need to be considered, they are all secondary to the overriding principle of the legal and ethical practice of nursing that any client has the right to refuse to participate in research using human subjects.

33) C

- Participative leadership demonstrates an "in-between" style, neither authoritarian nor democratic style. In participative leadership, the manager presents an analysis of problems and proposals for actions to team members, inviting critique and comments. The participative leader then analyzes the comments and makes the final decision. A laissez-faire leader abdicates leadership and responsibilities, allowing staff to work without assistance, direction, or supervision. The autocratic style of leadership is task oriented and directive. The situational leadership style utilizes a style depending on the situation and events.

34) C

Option C empowers the charge nurse to assist the staff nurse while trying to identify and reduce the behaviors that make it difficult for the staff nurse to function. Options A, B, and D are punitive actions, shift the burden to other workers, and do not solve the problem.

35) D

- The nurse should document task completion continuously throughout the day. Options A, B, and C identify accurate components of time management.



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Nursing Questions about Leadership and Management (26-30)

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26. A nurse notes that a postoperative client has not been obtaining relief from pain with the prescribed opioid analgesics when a particular licensed practical nurse (LPN) is assigned to the client. The appropriate action for the nurse to take is to:

a) reassign  the LPN to the care of clients not receiving opioids
b) notify the physician that the client needs an increase in opioid dosage
c) review the client's medication administration record immediately and discuss the observations with the nursing supervisor
d) confront the LPN with the information about the client having pain control problems and ask if the LPN is using the opioids personally

27. A medication nurse is supervising a newly hired licensed practical nurse (LPN) during the administration of oral pyridostigmine bromide (Mestinon) to a client with myasthenia gravis. Which observation by the medication nurse would indicate safe practice by the LPN?

a) asking the client to take sips of water
b) asking the client to lie down on his right side
c) asking the client to look up at the ceiling for  30 seconds
d) instructing the client to void before taking the medication

28. During orientation, a graduate nurse learns that the nursing model of practice implemented in the facility is a primary nursing approach. When the nurse attends report on the medical unit, the nurse will verify with the staff which of the following characteristics of primary nursing?

a)  critical paths are used when providing client care
b) the nurse manager assigns tasks to the staff members
c) a registered nurse (RN) leads nursing staff in providing care to a group of clients
d) a single RN is responsible for planning and providing individualized nursing care to clients

29. A clinical nurse manager conducts an inservice educational session for the staff nurses about case management. The clinical nurse manager determines that a review of the material needs to be done if a staff nurse stated that case management:

a)  manages client care by managing the client care environment
b) maximizes hospital revenues while providing for optimal client care
c) is designed to promote appropriate use of hospital personnel and material resources
d) represents a primary health prevention focus managed by a single case manager

30. A nurse manager is reviewing the critical paths of the clients on the nursing unit. The nurse manager collaborates with each nurse assigned to the clients and performs a variance analysis. Which of the following would indicate the need for further action and analysis?

a)  a client is performing his own colostomy care
b) purulent drainage is noted from a postoperative wound incision
c) a 1-day postoperative client has a temperature of 98.8F
d) a client newly diagnosed with diabetes mellitus is preparing his own insulin for injection





Nursing Questions about Leadership and Management
Answers and Rationale

26) C

- In this situation, the nurse has noted an unusual occurrence, but before deciding what action to take next, the nurse needs more data than just suspicion. This can be obtained by reviewing the client's record. State and federal labor and opioid regulations, as well as institutional policies and procedures, must be followed. It is therefore most appropriate that the nurse discuss the situation with the nursing supervisor before taking further action. The client does not need an increase in opioids. To reassign the LPN to clients not receiving opioids ignores the issue. A confrontation is not the most advisable action because it could result in an argumentative situation.

27) A

- Myasthenia gravis can affect the client's ability to swallow. The primary assessment is to determine the client's ability to handle oral medications or any oral substance. Options B and C are not appropriate. Option B could result in aspiration and option C has no useful purpose. There is no specific reason for the client to void before taking this medication.

28) D

- Primary nursing is concerned with keeping the nurse at the bedside actively involved in direct care while planning goal-directed, individualized client care. Option A identifies a component of case management. Option B identifies functional nursing. Option C identifies team nursing.

29) D

- Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal client care. It manages client care by managing the client care environment.

30) C 

- Variances are actual deviations or detours from the critical paths. Variances can be either positive or negative, or avoidable or unavoidable and can be caused by a variety of things. Positive variance occurs when the client achieves maximum benefit and is discharged earlier than anticipated. Negative variance occurs when untoward events prevent a timely discharge. Variance analysis occurs continually in order to anticipate and recognize negative variance early so that appropriate action can be taken. Option B is the only option that identifies the need for further action.




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Nursing Questions about Leadership and Management (21-25)

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21. A nursing student prepares a postoperative plan of care for a client scheduled for hypophysectomy. The registered nurse reviews the plan and informs the nursing student that the plan needs to be corrected if which of the following was noted?

a) obtain daily weights
b) administer mouth care
c) monitor intake and output
d) encourage coughing and deep breathing

22. A nurse manager is reviewing with the nursing staff the purposes for applying  wrist and ankle restraints (security devices) to a client. The nurse manager determines that further review is necessary when a nursing staff member states that an indication for the use of a restraint is to:

a) limit movement of a limb
b) keep the client in bed at night
c) prevent the violent client from injuring self and others
d) prevent the client from pulling out intravenous lines and catheters

23. A hospitalized client with a diagnosis of anorexia nervosa and in a state of starvation is in two-bed hospital room. A newly admitted client will be assigned to this client's room. Which client would be inappropriate to assign to this two-bed room?

a)  a client with pneumonia
b) a client who can perform self-care
c) a client with a fractured leg that is casted
d) a client who is scheduled for a diagnostic test

24. A multidisciplinary health care team is planning care for a client with hyperparathyroidism. The nurse identifies which client outcome to the health care team?

a) describes how to take antacids
b) restricts fluids to 1000 ml per day
c) describes how to take antidiarrheal medications
d) walks down the hall for 15 minutes, three times a day

25. A clinic nurse wants to develop a diabetic teaching program. In order to meet the client's needs, the nurse must first:

a)  assess the client's functional abilities
b) ensure that insurance will pay for participation in the program
c) discuss the focus of the program with the multidisciplinary team
d) include everyone who comes into the clinic in the teaching sessions






Nursing Questions about Leadership and Management
Answers and Rationale

21) D

- Toothbrushing, sneezing, coughing, nose blowing, and bending are activities that should be avoided postoperatively in the client who underwent a hypophysectomy. These activities interfere with the healing of the incision and can disrupt the graft. Options A, B, and C are appropriate postoperative interventions.

22) B

- Wrist and ankle restraints are devices used to limit the client's movement in situations when it is necessary to immobilize a limb. They are applied to prevent the client from injuring self or others; from pulling out intravenous lines, catheters, or tubes; or from removing dressings. Restraints also may be used to keep children still and from injuring themselves during treatments and diagnostic procedures. Restraints are not applied to keep a client in bed at night and should never be used as a form of punishment.

23) A

- The client in a state of starvation has a compromised immune system. Having a roommate with pneumonia would place the client at risk for infection. Options B, C, and D are appropriate roommates.

24) D

- Mobility of the client with hyperparathyroidism should be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposition to the formation of renal calculi. Fluids should not be restricted. Options A and C are not specifically associated with this disorder.

25) A

- Nurse-managed clinics focus on individualized disease prevention and health promotion and maintenance. Therefore the nurse must first assess the clients and their needs in order to effectively plan the program. Options B, C, and D do not address the clients' needs.


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