NCLEX Practice Questions, Part 3
A patient reports smoking 10 cigarettes per day for 40 years. How will the healthcare provider document this patient's smoking habit in terms of pack years? 5 pack years 10 pack years 4 pack years 20 pack years
20 pack years A pack contains 20 cigarettes. Calculate pack years by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. For example, 1 pack-year is equal to smoking 20 cigarettes (1 pack) per day for 1 year.
11. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection? A. Trichomoniasis B. Chlamydia C. Staphylococcus D. Streptococcus
B. Chlamydia Chlamydial infections are one of the most frequent causes of salpingitis or pelvic inflammatory disease.
A 17-year old girl and her mother are both in the exam room for the girl's school physical. Before asking the girl about her sexual history, which statement should the nurse make? a) "Mother, I'm going to ask you step out, so I can complete the health history." b) "Do you think your mother should leave the room now?" c) "The two of you seem so close. I'll ask questions about sexual history now." d) "Mother, do you think your daughter is sexually active?"
a) "Mother, I'm going to ask you step out, so I can complete the health history."
A 10-month old baby with a fractured right femur is admitted to the pediatric unit. Which action should the nurse take first? a) Ask the parents how the fracture occurred. b) Do a quick physical assessment. c) Administer pain medication. d) Ask the hospital social worker to come to the unit.
a) Ask the parents how the fracture occurred. In case of injury, especially among babies and children, it is very important that the nurse should first assess possible abuse. Reported suspected abuse is the responsibility of all healthcare professionals.
According to the CDC, when removing personal protective equipment (PPE) which item is removed first? a) Gloves b) Goggles c) Mask d) Gown
a) Gloves The Centers for Disease Control and Prevention recommends removing PPE in an order that minimizes contamination from pathogens. Since gloves are the "dirtiest," they are removed first. To make it easy to remember, remove the PPE in alphabetical order: gloves, goggles, gown, masks.
Due to a staff shortage, a nurse with only six months of experience is puled from his surgical unit to a medical unit. Which patient assignment is most appropriate for him? a) A 69-year old with COPD who is on a ventilator b) A 72 year-old who requires instruction on an incentive spirometer c) A 68-year old who has just returned from a bronchoscopy and biopsy d) A 58-year old on airborne precautions for active tuberculosis (TB)
b) A 72 year-old who requires instruction on an incentive spirometer When a nurse is pulled (or "floated" to a different unit, patients should be assigned that are compatible with the nurse's experience. The nurse should be assigned the patient who needs instruction on using an incentive spirometer. Many surgical patients are taught about coughing, deep breathing, and use of incentive spirometry preoperatively. To care for the patient with TB in isolation, the nurse must be fitted for a high-efficiency particulate air (HEPA) respirator mask. The bronchoscopy patient needs specific post-procedure care, and the ventilator-dependent patient requires a nurse who is familiar with ventilator care.
When a patient refuses treatment, this is an example of a) Civil law b) Common law c) Medical law d) Statutory law
b) Common law Common law allows a mentally competent adult to refuse medical treatment, even if it hastens death. Also called case or precedent law, it's based on past cases of a similar type. Individual cases contribute to the precedence for resolving a legal conflict. The right to refuse treatment is based on U.S. cases from 1891 and 1914. The judgment of the 1914 case (Schloendorff v. Society of New York Hospital) states, "Every human being of adult years and sound mind has a right to determine what shall be done with his own body..."
A child is admitted to the pediatric unit with a diagnosis of suspected meningococcal meningitis. Which of the following nursing measures should the nurse do FIRST? a) Institute seizure precautions b) Initiate respiratory isolation c) Document vital signs d) Assess neurologic status
b) Initiate respiratory isolation The initial therapeutic management of acute bacterial meningitis includes standard and respiratory (droplet) isolation precautions. Initiation of antimicrobial therapy should be immediate. Nurses should take necessary precautions to protect themselves and others from possible infection. Airborne or droplet isolation measures include: 1. Wear a mask when entering the patient's room. 2. A single patient room is preferred. If not available, spatial separations of more than 3 feet and drawing the curtain between beds is especially important. 3. When the patient is transferred or leaves the room, they should wear a mask if tolerated and follow respiratory hygiene.
When assigning tasks to unlicensed assistive personnel (UAP), the nurse can ask them to do all the following EXCEPT a) Report signs of skin breakdown b) Provide patient and family education c) Assist a patient who is choking d) Measure intake and output
b) Provide patient and family education
When assessing gross motor skills, for which infant should the nurse request a developmental referral? a) A 6-month old who does not creep. b) A 4-month old who is unable to sit without support. c) A 9-month old who is unable to stand while holding on. d) A 2-month old who does not roll over.
c) A 9-month old who is unable to stand while holding on. Over 90% of infants who are 9-months old can stand if they have something to hold onto. Rolling over should occur between 4-6 months; sitting without support is expected at 6 months. Creeping is normal at about 9 months.
The doctor orders a 24-hour ambulatory electrocardiography using a Holter monitor to a client with frequent fainting spells. To obtain the most accurate record, the nurse should instruct the client to avoid which of the following EXCEPT? a) Shaving with an electric razor. b) Using a cellular telephone. c) Eating with metal utensils. d) Standing close to a microwave.
c) Eating with metal utensils. Using electrical devices, such as electric razors and toothbrushes, may alter the data recorded with a Holter monitor. Patients are also generally advised to magnets, microwaves, electric blankets, cell phones, and MP3 players.
During a staff meeting, the supervisor reports on a recent infection control audit. Which finding indicates a need for staff training? a) A lab technician puts on a mask, gown, and gloves before entering the room of a patient on strict isolation b) A certified nursing assistant does not wear gloves when feeding an elderly patient c) A patient with active tuberculosis wears a mask when going to another department for testing d) A nurse with open lesions on her hands puts on gloves before giving direct patient care
d) A nurse with open lesions on her hands puts on gloves before giving direct patient care There is no need to wear gloves when feeding a client. However, universal (standard) precautions (treating all blood and body fluids as if they are infectious) should be followed in all situations. A client with active tuberculosis should be on respiratory precautions, including wearing a mask outside his private room. Staff members with exudative lesions or weeping dermatitis should not give direct care or handle patient-care equipment until the condition resolves, even if wearing gloves. Strict isolation requires the use of mask, gown, and gloves for anyone entering the room.
After educating a 19-year old client about possible adverse effects of her oral contraception, which of the client's concerns shows a lack of understanding? Headaches Ovarian cancer Nausea Weight gain
Ovarian cancer
A mother tells the nurse that her 8-year old doesn't eat as much as her toddler or teenager. The nurse should explain that school-age children have a lower... Activity level Hormone level Growth rate Metabolic rate
Growth rate
The healthcare provider is teaching a patient with emphysema pursed-lip breathing. Pursed lip breathing helps patients with emphysema because it... Helps the patient achieve maximum inhalation. Helps keep the small airways open and prevents air trapping. Increases the respiratory rate and oxygenation. Creates negative pressure in the airways.
Helps keep the small airways open and prevents air trapping. Pursed lip breathing (PLB)is one of the best ways to control shortness of breath. It improves ventilation by keeping the small airways open and releases air that is trapped in the lungs. It also extends the expiratory phase, which slows the breathing rate. Because patients with emphysema have less elastic recoil in their lungs, airways can collapse during expiration, air gets trapped, and exhalation is difficult. Cleveland Clinic suggests the following method to teach PLB: 1. Relax neck and shoulder muscles. 2. Inhale slowly through the nose for two counts, keeping the mouth closed. Don't take a deep breath; a normal breath will do. It may help to count silently: inhale, one, two. 3. Pucker or "purse" the lips as if whistling. 4. Exhale slowly and gently through the pursed lips for four counts.
The nurse plans to instruct parents of a 4-year old with cystic fibrosis (CF) about the child's nutritional needs. Which should be included during teaching? High calorie Low carbohydrate High fat Low protein
High calorie Children with cystic fibrosis require a high calorie, high protein diet in order to avoid failure to thrive syndrome. Other CF therapies include pancreatic enzyme replacement, fat-soluble vitamins, and supplemental feedings (gastrostomy or parental) if nutritional needs can't be met by eating.
When caring for an elderly client who has visual and hearing impairments, which of the following should the nurse assess? Cognitive decline Sensory overload Confusion and anger Social isolation
Social isolation Sensory impairments can lead to social isolation for older adults. Confusion and anger can be part of cognitive decline, which is a separate concern, unrelated to diminished vision or hearing. Sensory overload very unlikely.
A 32-year old client refuses to have any analgesia or anesthesia during her birth experience. As the nurse assists her during the second stage of her labor, which position should she use to begin pushing? Lithotomy position with high stirrups Squatting with her body curved into a "C" position Lying on her left side in the Sims' position Knee-chest position with head elevated
Squatting with her body curved into a "C" position Squatting helps enlarge the pelvic outlet and allows gravity to assist. The most efficient position is for the mother to squat with her body curved over her knees in a "C" position. Squatting can open the pelvis by 10%.
The Emergency Department notifies the pediatric unit of an admission of a 10-year old with bacterial meningitis. What type of isolation should be implemented? a) Droplet precautions b) Contact precautions c) Airborne precautions d) Standard precautions
a) Droplet precautions Bacterial meningitis is caused by exposure to through respiratory droplets. The droplets are heavy, and fall within 3 feet of the patient. Droplet precaution, in addition to standard precaution, requires a mask when giving direct care or coming into close vicinity of the patient. Standard precautions are general precautions taken with all patients.
A staff nurse is walking to lunch in the main corridor of the hospital when the code for infant abduction is announced. What should the staff nurse do? a) Observe people in the area who are carrying oversized coats or large bags. b) Contact the charge nurse of the nursery to obtain details. c) Go directly to the obstetrics unit to offer assistance as required. d) Quickly move to the hospital entrance and check each person who leaves.
a) Observe people in the area who are carrying oversized coats or large bags.
During initial rounds on the shift, the nurse finds that a patient's TPN solution has been infusing at a slower rate than ordered. It is now 2 hours behind. What should the nurse do? a) Continue at the same rate, and adjust the next bottle to infuse faster. b) Increase the infusion rate to return to the correct amount. c) Notify the physician to receive new infusion orders. d) Double the infusion rate for 2 hours, then return to the ordered rates.
c) Notify the physician to receive new infusion orders. When TPN infusion rate changes by 10% (either increase or decrease) the patient's blood glucose level can be drastically altered. Always notify the physician to receive a new order to adjust the rate.
In the event of a fire in a client's home, your first action is to _______. a) report the fire to your agency. b) get the fire extinguisher. c) move the client to a safe place. d) turn on the fire alarm.
c) move the client to a safe place. The nurse should be familiar with exits and location of fire extinguishers. If a smoke or fire alarm sounds, your first action is to keep the client safe. Remember "R.A.C.E." to quickly act. R = Rescue/Remove the client. A = Alarm, if the alarm is not connected to the fire department, call 911 to report it. . C = Confine/Contain the fire or smoke by closing doors to prevent or slow the spread. Smoke is especially dangerous for everyone. E = Extinguish the fire if possible, using a handheld fire extinguisher. Attempt to extinguish only small fires, as long as you and the client can remain safe, and have an escape route.
