NCLEX RN Practice Test 5

use pictures and gestures.

Alcohol is a central nervous system depressant. These symptoms are the body’s neurological adaptation to the withdrawal of alcohol.

Betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. Nalbuphine is an opioid analgesic. Rho(D) immune globulin is given to Rh-negative clients to prevent sensitization. Dinoprostone vaginal insert is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions.

Phenomenological

3, 1, 5, 2, 4. The sperm are produced
in the testes (3). They then proceed to the epididymis (1) where they mature. The vas deferens (5) is the conduit through which the sperm first travel during ejaculation. The prostate (2), encircling the neck of the urethra, produces a fluid that protects the sperm, and, finally, the sperm exit the male body via the urethra (4).

Flushing of the line is required when giving Dilantin IV push because Dilantin crystallizes in the tubing if D5W is present. Answers A B and D would not be appropriate or necessary for this procedure.

Green-tinged amniotic fluid is indicative of meconium staining. This finding indicates fetal distress. The presence of scant bloody discharge is normal as are frequent urination and moderate uterine contractions making answers A B and D incorrect.

All soiled equipment used in an infectious patient are disposed inside the client’s room to prevent contamination outside the room. Using the mask to cover both nose and mouth is correct. Hands are washed before removing the gloves and before and after your enter the client’s room. Gloves and contaminated suction tip are thrown in the trash found in the client’s room.

Right Answer is:
2% Glutaraldehyde immersion for 10 hours

Overt

1. Estrogen begins to elevate before ovulation. It is not responsible for the temperature elevation.
2. Progesterone elevation occurs after ovulation and spikes at about 5-6 days after ovulation. Progesterone is thermogenic—that is, heat producing. Progesterone is the reason why women’s temperatures are elevated following ovulation.
3. LH spikes at the time of ovulation. 4. FSH promotes the maturation of the ovum.

According to Erikson, the child focuses on gaining some basic control over self and the environment and independence between ages 1 and 3 years. Gaining independence often means that the child has to rebel against the parents’wishes. Saying things like “no” or “mine” and having temper tantrums are common during this period of development. Being consistent
and setting limits on the child’s behavior are necessary elements. Providing a simple explanation of why certain behaviors are unacceptable is an appropriate action. Options 2 and 3 do not address the child’s behavior. Option 5 is likely to produce a negative response during this normal developmental pattern.

Peripheral blood smear

The client with diverticulitis should avoid foods with seeds. The foods in answers A B and D are allowed; in fact bran cereal and fruit will help prevent constipation.

Obtain baseline behavioral indicators from family members.
Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.

The nurse should tell the client to change position or turn side to side in order to improve the dialysate return. Answers A B and C are incorrect ways of managing peritoneal dialysis; therefore they are incorrect choices.

The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs aren’t used to manage alcohol withdrawal syndrome.

Descriptive

The major complication of SLE is lupus nephritis which results in end-stage renal disease. SLE affects the musculoskeletal integumentary renal nervous and cardiovascular systems but the major complication is renal involvement; therefore answers B and D are incorrect. Answer C is incorrect because the SLE produces a butterfly rash not desquamation.

Upon the patient’s arrival in the operation room

Following pericardiocentesis, the client usually expresses immediate relief. Heart sounds are no longer muffled or distant and blood pressure increases. Distended neck veins are a sign of increased venous pressure, which occurs with cardiac tamponade.

It takes 1-2 weeks for mood stabilizers to achieve a therapeutic effect; therefore antipsychotic medications can also be used during the first few days or weeks to manage behavioral excitement. Answers A and D are not true statements and therefore are incorrect. Answer C is incorrect because the combination of medications will not allow for hypomania.

Hypertension

Isoniazid (INH) interferes in the effectiveness of oral contraceptives and clients of childbearing age should be counseled to use an alternative form of birth control while taking this drug.

Orientation phase is synonymous with CONTRACT ESTABLISHMENT. Here, the nurse will establish regular meeting of schedule, agreements and giving the client information that there is a TERMINATION. Letter A and B assesses the client’s coping skills, which is in the working phase and so is letter B. In working phase, The nurse assesses the coping
skills of the client and formulate plans and intervention to correct deficiencies. Although assessment is also made in the orientation phase, COPING SKILLS are assessed in the working phase.

Right Answer is:
Residual urine

Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports. The safe activity for them is swimming.

It may take 4 to 6 months to eat anything, but most people can eat anything they want.

Walking and swimming are very helpful in strengthening back muscles for the client suffering from lower back pain.

Sensitivity is an attribute of the instrument that allow the respondents to distinguish differences of the options where to choose from

Swelling can obstruct nasal breathing, interfering with the senses of taste and smell.

Academic deficits, an inability to function within constraints required of certain settings, and negative peer attitudes often lead to low self-esteem.

The nurse can help ready the child with cerebral palsy for speech therapy by providing activities that help the child develop tongue control. Most children with cerebral palsy have visual and auditory difficulties that require glasses or hearing devices rather than rehabilitative training; therefore answers A and C are incorrect. Answer D is incorrect because video games are not appropriate to the age or developmental level for the child with cerebral palsy.

Needles, scalpels and other sharps are to be disposed in a puncture proof container.

In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. The other findings are within normal limits.

Bethanechol chloride can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could damage or rupture the bladder in clients with these conditions.

100,000 IU

Answer: (B) Oxytocin can make the cervix close and thus trap the placenta inside
The action of oxytocin is to make the uterus contract as well make the cervix close. If it is given prior to placental delivery, the placenta will be trapped inside because the action of the drug is almost immediate if given parentally.

The nurse should directly orient a delusional client to reality, especially to place and person. Options A and C may encourage further delusions by denying poisoning and offering information related to the delusion. Validating the client’s feelings, as in option D, occurs during a later stage in the therapeutic process.

The nurse should first provide for the clients safety including protecting her from an embarrassing situation. Answer A is incorrect because it allows the client to continue unacceptable behavior. Answer B is incorrect because it does not stop the clients behavior. Answer C is incorrect because it focuses on the other clients not the client with inappropriate behavior.

2001-2002

Sepsis

Clients with radium implants should have close contact limited to 30 minutes per visit. The general rule is limiting time spent exposed to radium putting distance between people and the radium source and using lead to shield against the radium. Teaching the family member these principles is extremely important. Answers A B and C are not empathetic and do not address the question; therefore they are incorrect.

Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

Both parties involved are committed in solving the conflict

According to Jean Piaget’s theory of cognitive development, it is normal for the infant or toddler not to recognize that objects continue to be in existence, even if out of the visual field; however, this is abnormal for the 6-year-old. If a 6-year- old child does not recognize that objects still exist even when outside the visual field, the child is not progressing normally through the developmental stages. The nurse should report this finding to the health care provider. Options 2, 3, and 4 delay necessary follow-up and treatment.

The client with a lumbar laminectomy can be safely cared for by the LPN. Answer A is incorrect because the client with a high cervical injury immobilized by skeletal traction is best cared for by the RN. Answers B and D are incorrect choices because these clients have conditions that require intravenous medication which requires the skill of the RN.

A normal respiratory rate for a newborn is 30-40 breaths per minute.

The human body requires glucose for the brain and nervous system, and a diet that has very few or no dietary carbohydrates forces it to generate this glucose from protein through gluconeogenesis, with an efficiency of approximately 57% (protein and carbohydrate are approximately equal in calorific value; each has about four kilocalories per gram, but gluconeogenesis can produce only 57g of glucose from 100g of protein). This could be a significant contributor to metabolic advantage.

Answer: (A) 1 and 3
The nurse after delivering the placenta must ensure that all the cotyledons and the membranes of the placenta are complete. Also, the nurse must check if the umbilical cord is normal which means it contains the 3 blood vessels: 1 vein and 2 arteries.

Equipment with large lumen are easier to clean compared to those with small lumen. Other choices are correct.

Educable, can reach up to grade 6 and has a maturity of a 12 year old

Those under early case detection

In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical and restricted abduction of the affected hip, when the child is placed supine with the knees and hips flexed, would be an assessment finding in developmental dysplasia of the hip in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.

Leg cramps is caused by the contraction of the gastrocnimeus (leg muscle). Thus, the intervention is to stretch the muscle by dosiflexing the foot of the affected leg towards the knee.

Blood levels must be checked monthly or bimonthly when the client is on maintenance therapy because there is only a small range between therapeutic and toxic levels.

A dry sterile dressing such as a sterile 2 AÌ‚ 2 gauze is used to apply pressure to the discontinued IVsite. This material is absorbent, sterile, and nonirritating. Apovidone iodine swab would irritate the opened puncture site and would not stop the blood flow. An adhesive bandage or elastic wrap may be used to cover the site once hemostasis has occurred.

Acute rheumatic fever

At lithium levels of 2 to 2.5 mEq/L the client will experienced blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting. With levels between 1.5 and 2 mEq/L the client experiencing vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion. At lithium levels of 2.5 to 3 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death.

Increased WBC

Bending at the waist increase IOP and should be avoided by patients with glaucoma. Treatment for glaucoma is usually for life. Patients are given laxatives to avoid stratining at the stool. They should avoid all activities that will lead to sudden IOP increase like bending at the waist. Clients should bend at the knees.

Total parenteral nutrition formulas contain dextrose in concentrations of 10% or greater to supply 20% to 50% of the total calories. Blood glucose levels should be checked every 4 to 6 hours. A sliding scale dose of insulin may be ordered to maintain the blood glucose level below 200mg/dl.

Stage of Resistance

B, A, and C only

Path Goal theory according to House and associates rewards good performance so that others would do the same.

Blood in the sputum.

Subcutaneous

CBR means complete bed rest.

Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary.

The medication should be withheld and the doctor should be notified. Answers A B and D are incorrect because they do not provide for the clients safety.

Egyptians believe that a sick person is someone with an evil force or demon that is inside their heads. To release these evil spirits, They would tend to drill holes on the patient’s skull and it is called TREPHINING.

Right Answer is:
The infant develops a congenital defect shortly after birth that causes the destruction of red blood cells.

Use of Non Judgemental and Consistent approach

The anterior fontanel is larger in size than the posterior fontanel. Additionally, the anterior fontanel, which is diamond shaped, closes at 18 months, whereas the posterior fontanel, which is triangular shaped, closes at 8 to 12 weeks. Neither fontanel should appear bulging, which may indicate increased intracranial pressure, or sunken, which may indicate dehydration.

Regular coffee contains caffeine which acts as psychomotor stimulants and leads to feelings of anxiety and agitation. Serving coffee top the client may add to tremors or wakefulness.

Listen to the patient’s concerns

Nutrition, Long term immunosuppression and drug abuse are all factors that affects the resistance of an individual in acquiring communicable diseases. Other factors includes extremes of ages, poor environmental sanitation, poverty and poor living conditions. Diabetes insipidus does not, in anyway alter a persons immune response.

The diet for a breast-feeding client should include additional fluids. Prenatal vitamins should be taken as prescribed, and soap should not be used on the breasts because it tends to remove natural oils, which increases the chance of cracked nipples. Breast-feeding is not a method of contraception, so birth control measures should be resumed.

These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.

Immunosuppressed clients — for example, clients receiving chemotherapy, — are at risk for infection with C. difficile, which causes “horse barn” smelling diarrhea. Successful treatment begins with an accurate diagnosis, which includes a stool test. The ELISA test is diagnostic for human immunodeficiency virus (HIV) and isn’t indicated in this case. An electrolyte panel and hemogram may be useful in the overall evaluation of a client but aren’t diagnostic for specific causes of diarrhea. A flat plate of the abdomen may provide useful information about bowel function but isn’t indicated in the case of “horse barn” smelling diarrhea.

By one year of age the infant is expected to triple his birth weight. Answers A B and C are incorrect because they are too low.

35.8 – 37.4 C

Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle movements, pseudoparkinsonism and tar dive dyskinesia.

In an emergency like this, The first thing the nurse should do is maintaining the airway patency. With the cannunlas dislodged, The stoma will stenosed and narrows giving james an obstructed airway. The nurse would insert the kelly clamp to open the stoma and lock the clamp in place to maintain it open while she uses an obturator as to prevent further stenosis of the stoma. An obturator is a part of the NGT package included by most manufacturers to guide the physician or nurses in inserting the outer cannula.

Severe pressure-like pain out of proportion to visible signs distinguishes necrotizing fasciitis from cellulites. Erythema, leukocytosis, and swelling are present in both cellulitis and necrotizing fasciitis.

An autopsy is required by state law in certain circumstances, including the sudden death of a client and a death that occurs under suspicious circumstances. A client may have provided oral or written instructions regarding an autopsy after death. If an autopsy is not required by law, these oral or written requests will be granted. If no oral or written instructions were provided, state law determines who has the authority to consent for an autopsy. Most often, the decision rests with the surviving relative or next of kin.

Right Answer is:
Surgeon

The answer given to question “what brought you to the hospital”

Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as late menopause or a history of anovulatory cycles are associated with fibrocystic disease. Masses associated with fibrocystic disease of the breast are firm, most often located in the upper outer quadrant of the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable.

Suckling of the nipple stimulates the release of oxytocin by the posterior pituitary gland, which causes uterine contraction. Lactation begins 1 to 3 days after delivery. Nipple stretching exercises are done when the nipples are flat or inverted. Frequent washing dries up the nipples, making them prone to the formation of fissures.

Donor sperm are introduced vaginally into the uterus or cervix

The nurse would use role-playing to teach the client appropriate responses to others and in various situations. This client dramatizes events, drawn attention to self, and is unaware of and does not deal with feelings. The nurse works to help the client clarify true feelings & learn to express them appropriately.

Right Answer is:
Temperature

Lying on the left side may prevent air from flowing into the pulmonary veins. The Trendelenburg position increases intrathoracic pressure, which decreases the amount of blood pulled into the vena cava during aspiration.

Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

Mild anxiety is anxiety that is manageable without any additional techniques. Mild anxiety tends to be when you have irritating symptoms that don’t seem to go away, but otherwise don’t control you.

Synthetic thyroid hormones

Difficulty of hearing

Each rural health midwife is given a population assignment of about 5,000.

The nurse should give priority to maintaining the clients airway. The ABCDs of trauma care are airway with cervical spine immobilization breathing circulation and disabilities (neurological); therefore answers B C and D are incorrect.