NCLEX style review questions from powerpoints

A patient with a new ileostomy is preparing to go home. What should the patient be taught about changing his ileostomy? A Apply moisturizing lotion after cleaning the stoma. B Apply a skin barrier to the peristomal skin prior to applying the pouch. C Dispose of the clamp with each bag change. D Cleanse the area surrounding the stoma with alcohol.

B

Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are a.Obesity and smokeless tobacco use. b.Hypertension and cigarette smoking. c.Elevated serum lipids and diabetes mellitus. d.Physical inactivity and elevated homocysteine levels.

B Rationale: An elevated blood pressure and cigarette smoking (causes vasoconstriction) increase the rate of atherosclerosis. Atherosclerosis increases the workload of the heart and increases myocardial oxygen demand.

The nurse suspects that a patient who is receiving NG suction has hypokalemia. What manifestations would the nurse expect this patient to exhibit? A.Increased bowel motility B.ECG changes C.Increased muscle strength D.Agitation

B Rationale: ECG changes with hypokalemia can include flat T waves or inverted T waves or both, suggesting ischemia, and depressed ST segments. Decreased bowel motility, fatigue, and weakness may also accompany the problem.

An ICU nurse has orders to infuse a hypertonic solution. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. What term is described by this process? A.Hydrostatic pressure B.Osmosis C.Diffusion D.Active transport

B •Rationale: Osmosis is the movement of fluid from a region of low solute concentration to the region of high solute concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to water pressure, and active transport is the movement of molecules against the concentration gradient. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration.

Sally Mio has severe dehydration due to being deprived of water when she was lost in the woods. She has poor skin turgor, temp is 98.6. Which are her vital signs: A. BP 100/60, HR 48, Resp 16 B. BP 85/45, HR 48, Resp 18 C. BP 85/45, HR 110, Resp 24 D. BP 148/88, HR 120, Resp 12

C

What defense mechanism is portrayed in the following scenario? After throwing his lunch on the floor, a patient complains about the quality of food he is being fed during his hospital stay. A. Denial B. Displacement C. Rationalization D. Reaction formation

C

Which respiratory part of the respiratory tract is the site of gas exchange? A. Mediastinum B. Parietal pleura C. Alveoli D. Diaphragm

C

The nurse caring for a patient with an MI knows that the top priority in the care of this patient is what? A.Balancing intake and output B.Decreasing energy expenditure of the myocardium C.Balancing myocardial oxygen supply with demand D.Decreasing nutritional need of myocardial muscle

C Rationale: Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the patient with an MI. This supersedes interventions related to nutrition, fluid balance, or energy expenditure.

A person who exaggerates the good qualities of his recently deceased father is experiencing what stage of Engel's grief? A. Shock and disbelief B. Restitution C. Idealization D. Outcome

C Rationale: Idealization is the exaggeration of the good qualities the person or object had, followed by acceptance of the loss. Shock and disbelief are defined as refusal to accept the loss, followed by a stunned response. Restitution involves the rituals surrounding the loss. Outcome involves dealing with the loss as a common life occurrence.

The nurse determines that teaching about implementing dietary changes to decrease the risk of CAD has been effective when the patient says, a."I should not eat any red meat such as beef, pork, or lamb." b."I should have some type of fish at least 3 times a week." c."Most of my fat intake should be from olive oil or the oils in nuts." d."If I reduce the fat in my diet to about 5% of my calories, I will be much healthier."

C Rationale: Monounsaturated fats are found in natural foods such as nuts and avocados, and are the main component of tea seed oil and olive oil (oleic acid). Canola oil is 57% to 60% monounsaturated fat, olive oil is about 75% monounsaturated fat, and tea seed oil is commonly more than 80% monounsaturated fat. Other sources include macadamia nut oil, grapeseed oil, groundnut oil (peanut oil), sesame oil, corn oil, popcorn, whole grain wheat, cereal, oatmeal, safflower oil, sunflower oil, tea-oil Camellia, and avocado oil. Fat intake should be between 25% and 35% of calories (with most from monounsaturated fats and less from saturated fats); red meats should be reduced or eliminated from the diet. Only fatty fish (such as tuna and salmon) should be included in the diet because fatty fish is high in omega-3 fatty acids.

A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which order should the nurse question? a.Oxygen at 4 L/min per nasal cannula b.Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved c.Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours d.IV nitroglycerin at 5 mcg/minute and increase 5 mcg/minute every 3 to 5 minutes

C Rationale: Traumatic or prolonged (>10 minutes) cardiopulmonary resuscitation is a relative contraindication for the administration of fibrinolytic therapy.

The MD has ordered some IV fluids for Sally. Which is the least appropriate? A. Hypertonic B. Isotonic C. Hypotonic

C. Hypotonic

An elderly person who is placed in a nursing home by his family is remorseful about the loss of his financial independence. What is the term for the type of loss he is experiencing? A. Physical loss B. Psychological loss C. Actual loss D. Perceived loss

D Rationale: Perceived loss is felt by the person, but intangible to others, as is the case with loss of financial independence. Physical loss and actual loss can be recognized by others as well as the person sustaining the loss. Psychological loss may be caused by an altered self-image.

A 75-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. An emergency room nurse is obtaining assessment data from this patient. What assessment finding is characteristic of a small bowel obstruction? A Nausea and vomiting B Decrease in urine production C Mucus in the stool D Mucosal edema

A

What does NORMAL bowel function look like? A. Strong peristaltic movements 1-4 times a day B. Bowel movements every day C. Slight pain with bowel movements D. Absence of flatus

A

A patient's recent fatigue has been attributed to hypoproliferative anemia. You are aware that this health problem is a result of: A.Inadequate RBC production B.Active loss of RBCs C.Damage to the circulating RBCs D.Distortions in the shape of RBCs

A Rationale: Hypoproliferative anemia is usually a result of inadequate numbers of RBCs being produced by the bone marrow. It is not a result of changes in morphology, premature destruction, or blood loss.

Which of the following situations would most likely prompt an increase in erythropoietin synthesis? A.A woman is admitted to the hospital with anemia. B.A man with atrial fibrillation has begun taking anticoagulants to prevent a stroke. C.A child fractures his ulna and radius in a playground accident. D.A woman develops an infection in an arterial ulcer.

A Rationale: If the kidney detects low levels of oxygen (as would occur in anemia, in which fewer red cells are available to bind oxygen, or with people living at high altitudes), the release of erythropoietin is increased. Anticoagulants, infections, and injury without blood loss do not increase erythropoiesis.

Which patient is most at risk for developing coronary artery disease? a.A hypertensive patient who smokes cigarettes b.An overweight patient who uses smokeless tobacco c.A patient who has diabetes and uses methamphetamines d.A sedentary patient who has elevated homocysteine levels

A Rationale: The four major modifiable risk factors for coronary artery disease are elevated serum lipids, hypertension, tobacco use, and physical inactivity. Other risk factors include diabetes mellitus, metabolic syndrome, psychologic states, high levels of homocysteine, and substance abuse.

An example of situational stress is the stress related to a marriage or divorce. A. True B. False

A. True

In the stress management technique known as anticipatory guidance, a person creates a mental image, concentrates on the image, and becomes less responsive to stimuli. A. True B. False

B. False

A woman was diagnosed with peptic ulcers several months ago and has been vigilant about implementing the nurse's recommended lifestyle modifications. The woman states that she is motivated to control her ulcers because she has a sister who had to be hospitalized for the treatment of a bleeding ulcer. A bleeding ulcer is strongly suggested when a patient exhibits: A Chronic constipation B Early morning heartburn C Nausea that is relieved by eating D Melena stool

D

The nurse is caring for a 77-year-old patient with diarrhea. What would be especially important to monitor this patient for? A Pain B Fluid overload C Fatigue D Dehydration

D

True or false? A patient who is experiencing hypovolemia is likely to have a weak, rapid pulse and hypotension.

True Rationale: Hypovolemia often results in a weak, thready pulse with a rate that is higher than normal. At the same time, the patient is likely to have low blood pressure due to low vascular volume.