NCLEX Practice Questions to Remember

A home care nurse is visiting an 88-year-old man, who is taking acetaminophen for arthritic pain in his knees. Which of the following patient teaching statements is most appropriate to implement? A. "Acetaminophen will only relieve pain but not the inflammation from arthritis." B. "Acetaminophen is appropriate for the treatment of inflammation from arthritis." C. "Your primary health care provider should consider a prescription of Vicodin (acetaminophen/hydrocodone)." D. "The acetaminophen should be administered on an empty stomach."

A

A nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the nurse expect to administer to the client? A. Acetylcysteine B. Beclomethasone C. Ipratropium D. Azelastine

A. Acetylcysteine this is a mucolytic that will loosen respiratory secretions

A healthcare professional is caring for a patient who is about to begin iron dextran therapy. When administering the drug IM, the health care professional should take which of the following actions? (Select all that apply.) A. Administer a test dose B. Monitor blood pressure C. Have epinephrine available D. Premedicate with atropine E. Use the z track technique

A. Administer a test dose (can cause a hypersensitivity reaction) B. Monitor blood pressure (can cause hypotension) C. Have epinephrine available (can cause hypersensitivity reaction) E. Use the z track technique (best practice, preferably in ventrogluteal)

A health care professional is caring for a patient who was given succinylcholine, a depolarizing neuromuscular blocker, during a surgical procedure. The patient develops rigid muscles, tachycardia, and a sudden spike in temperature. The health care professional should immediately suspect which of the following? A. Malignant hyperthermia B. Neuroleptic malignant syndrome C. Toxic epidermal necrolysis D. Stevens-Johnson syndrome

A. Malignant hyperthermia Succinylcholine and inhalation anesthetics can trigger malignant hyperthermia, a potentially fatal condition. It causes muscle rigidity and an increase in body temperature.

A nurse is assessing a client who is postoperative following an outpatient endoscopy procedure using midazolam. The nurse should monitor for which of the following findings as an indication that the client is ready for discharge? A. the client's capnography has returned to baseline B. the client can respond to their name when called C. the client is passing flatus D. the client is requesting oral intake

A. the client's capnography has returned to baseline The nurse should identify that the client is ready for discharge when the capnography level indicates that gas exchange is adequate.

In order for tissue plasminogen activator (tPA) to be most effective in the treatment of stroke, it must be administered? A. 6 hours after the onset of stroke symptoms B. 3 hours before the onset of stroke symptoms C. 3 hours after the onset of stroke symptoms D. 12 hours before the onset of stroke symptoms

C

You are obtaining a health history from a patient who is to start using a new ipratropium (Atrovent) inhaler. Which of the following information from the patient's history should alert you to take further action? (Select all that apply.) A) Seizure disorder B) Peanut allergy C) Depression treated with a monoamine oxidase inhibitor (MAOI) D) Hypothyroidism treated with synthetic thyroid hormone E) Glaucoma

B) Peanut allergy E) Glaucoma contraindicated for patients with peanut allergies, and must use extreme caution with glaucoma and BPH patients

Which patients are NOT a candidate for tissue plasminogen activator (tPA) for the treatment of stroke? SATA: A. A patient with a CT scan that is negative. B. A patient whose blood pressure is 200/110. C. A patient who is showing signs and symptoms of ischemic stroke. D. A patient who received Heparin 24 hours ago.

B, D

A primary care provider who is considering the various pharmacologic options for a patient who has peptic ulcer disease should understand that which of the following drugs require monitoring of the patient's phosphorus levels? A. Omeprazole B. Aluminum hydroxide C. Sucralfate D. Ranitidine

B. Aluminum hydroxide Antacids that contain aluminum, such as aluminum hydroxide, can cause hypophosphatemia because of aluminum's ability to bind with phosphate and decrease its absorption. The drug requires monitoring of phosphorus levels.

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over the counter medications? A. Aspirin B. Ibuprofen C. Ranitidine D. Bisacodyl

B. Ibuprofen Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently.

When treating a patient who has malignant hyperthermia, the health care professional should do which of the following? (Select all that apply.) A. Administer a depolarizing neuromuscular blocking agent B. Provide cooling measures C. Administer dantrolene D. Discontinue anesthesia E. Reduce the IV fluid infusion rate

B. Provide cooling measures C. Administer dantrolene D. Discontinue anesthesia

A health care professional is caring for a patient who has benign prostatic hypertrophy and is taking tamsulosin (Flomax). The health care professional should question the use of the following? A. a seizure disorder for which he takes carbamazepine B. erectile dysfunction for which he takes sildenafil C. diabetes mellitus for which he takes glyburide D. angle-closure glaucoma for which he takes pilocarpine

B. erectile dysfunction for which he takes sildenafil tamsulosin inhibits smooth muscle contraction = hypotension sildenafil promotes relaxation in penile muscles = hypotension

What is the antidote for magnesium sulfate? A. calcium carbonate B. calcium acetate C. calcium gluconate D. calcium phosphate

C

A nurse in the emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer? A. Potassium iodide B. Glucagon C. Atropine D. Protamine

C. Atropine Myasthenia gravis (MG) is a chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle, resulting in weakness of the skeletal muscles medications like Neostigmine, a cholinesterase inhibitor , are used in the symptomatic treatment of myasthenia gravis by improving muscle tone A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. cholinergic medications mimic the activity of the parasympathetic nervous system The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity.

When talking with a patient about taking loperamide (Imodium), the health are professional should include which of the following instructions? A. Dissolve the powder thoroughly in 8 oz of water B. Have diphenhydramine available C. Avoid activities that require alertness D. Take 30 min before activities that trigger nausea

C. Avoid activities that require alertness Loperamide, an opioid agonist, can cause sedation and dizziness. The health care professional should caution the patient about not taking it before activities that require alertness. loperamide treats diarrhea, not nausea

A health care professional is preparing to administer neostigmine (Prostigmin) to a patient who has myasthenia gravis. Knowing the adverse effects of neostigmine, which of the following drugs should the health care professional have ready to administer? A. lidocaine B. epinephrine C. atropine D. amiodarone

C. atropine It is important to have atropine, an anticholinergic, available to reverse bradycardia that can result from the administration of neostigmine, a cholinesterase inhibitor.

A nurse is planning care for a client who is receiving mannitol via IV continuous infusion. The nurse should monitor the client for which of the following adverse effects? A. Weight loss B. Increase intraocular pressure C. Auditory hallucinations D. Bibasilar crackles

D. Bibasilar crackles A and B are expected therapeutic outcomes. C is not a adverse side effect of mannitol

A health care professional is talking to a patient who is newly diagnosed with Parkinson's disease about how levodopa/carbidopa (Sinemet) will help control her symptoms. With which of the following mechanisms is the drug effective in treating the disorder? A. Increases available acetylcholine in the brain B. Inhibits norepinephrine metabolism in the brain C. Inhibits serotonin metabolism in the brain​ D. Increases available dopamine in the brain

D. Increases available dopamine in the brain

The nurse is assessing the family dynamics of a widow with end stage terminal cancer. Which statement made between the adult children would best indicate the need for further teaching? a. "The doctors have told us that it is time for us to b. "Since you are the oldest child, you have the responsibility to decide." make some tough decisions." c. "It does not matter what we think, the living will says 'do not resuscitate'." d. "If daddy were alive, he would be making these hard decisions, not us."

c. "It does not matter what we think, the living will says 'do not resuscitate'." In the legal hierarchy (order of importance), when the client is unable to make decisions and there is no spouse to decide, the next decision-maker is the oldest adult child.

The nurse is caring for four clients receiving chemotherapy. Which of the following clients should the nurse see first? a. A client with ovarian cancer with a white blood cell count of 4,500 cells/mcL b. A client with cervical cancer and a hemoglobin level of 8.2 mg/dL c. A client with endometrial cancer and a potassium level of 5.0 mEq/L d. A client with breast cancer and a sodium level of 115 mEq/L

d. A client with breast cancer and a sodium level of 115 mEq/L

The nurse is caring for a client admitted with diverticulitis. The client reports severe abdominal pain and assessment reveals that the client's abdomen is rigid and tender. The client's vital signs are: T: 101.8 F (38C); HR: 120; B/P: 100/50. Urine output was less than 300 ml during the previous eight hours. The client states the pain is "worse than before". What is the priority nursing intervention for this client? a. Administer the prescribed scheduled antibiotic b. Encourage the client to increase fluids c. Administer bisacodyl suppository as needed d. Notify the client's health care provider

d. Notify the client's health care provider

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. the nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives? A. carbamazepine B. sumatriptan C. atenolol D. glipizide

A. carbamazepine Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes.

A nurse is caring for a client who is receiving filgrastim. Which of the following findings should the nurse document to indicate the effectiveness of the therapy? A. increased neutrophil count B. increased RBC count C. decreased prothrombin time D. decreased triglycerides

A. increased neutrophil count Filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized.

A health care professional is caring for a patient who is about to begin taking pramipexole (Mirapex) to treat Parkinson's disease. The health care professional should recognize that which of the following laboratory tests require monitoring? A. C-reactive protein B. Creatine phosphokinase (CPK) C. Thyroid function D. CBC

B. Creatine phosphokinase (CPK) CPK is an enzyme found in the heart, brain, and skeletal muscles. Monitoring CPK can alert health care professionals to the possibility of skeletal muscle damage from the drug.

A health care professional who is advising a patient about the use of an expectorant to treat a cough should explain that this type of drug is effective because it performs which of the following actions? A. Suppresses the cough stimulus B. Reduces surface tension C. Reduces inflammation D. Dries mucous membranes

B. Reduces surface tension Expectorants act by reducing the surface tension of respiratory secretions. An expectorant does not suppress the cough stimulus. Antitussives, such as dextromethorphan (Robitussin), have this therapeutic effect.

When talking with a patient about taking metoclopramide (Reglan) to treat GERD, the health care professional should include which of the following instructions? A. Take the drug once a day in the morning. B. Stop taking the drug if drowsiness develops. C. Chew gum or suck on hard candy. D. Take acetaminophen (Tylenol) for headaches.

C. Chew gum or suck on hard candy. Metoclopramide, a prokinetic, can cause anticholinergic effects, including dry mouth. Chewing gum, sucking on hard candy, and sipping water can help minimize this effect.

A nurse is assessing the health status of an older adult client. Although the client denies a problem, the caregiver explains that the client is alert and oriented but consistently has an unkempt appearance, body odor, and soiled clothing. The nurse understands that the client's behavior is likely related to which of the following? A. Manifesting typical early symptoms of delirium. B. Exhibiting evidence of asymptomatic pathology. C. Restricting activities in response to disease symptoms. D. Experiencing side effects from a medication.

C. Restricting activities in response to disease symptoms. Delirium is characterized by an abrupt disturbance in consciousness, typically manifesting as disorientation, first to time, then place, and lastly to person. Disorientation and confusion may be markedly worse at night and during the early morning. Neglect of personal hygiene is not an early characteristic of delirium, but disorientation may cause a decline in functional health status.

A patient taking oral contraceptives calls her health care professional because she forgot to take one of her pills. Which of the following instructions should the health care professional provide? A. Take a pregnancy test. B. Avoid vaginal intercourse until after your next period. C. Take the missed dose along with the next dose. D. Stop the oral contraceptive and use a different contraceptive.

C. Take the missed dose along with the next dose. Health care professionals should tell patients to take the missed dose along with the next dose. Should the patient miss two doses, she should take an additional dose each day for the next 2 days.

A health care professional is preparing to administer neostigmine to a patient. Which of the following information in the patient's health history should alert her to use caution when administering neostigmine? A. glaucoma B. thrombocytopenia C. hepatitis D. asthma

D. asthma Neostigmine can cause bronchospasm

A health care professional is caring for a patient who takes phenytoin (Dilantin) for a seizure disorder and is about to begin sucralfate (Carafate) therapy to treat a duodenal ulcer. The health care professional should tell the patient to take the drugs at least 2 hr apart because: A. phenytoin increases the metabolism of sucralfate B. phenytoin reduces the effectiveness of sucralfate C. sucralfate increases the risk of phenytoin toxicity D. sucralfate interferes with the absorption of phenytoin

D. sucralfate interferes with the absorption of phenytoin

A health care professional is advising a patient about the use of beclomethasone to treat asthma. The health care professional should explain that the drug treats asthma because it performs which of the following actions? A. Thin mucus B. Relaxes bronchial smoother muscle C. Decreases inflammation D. Increases the cough threshold

C. Decreases inflammation

A client is hospitalized for multiple rib fractures following a motor vehicle accident (MVA). The results of an arterial blood gas (ABG's) are; pH 7.30, pCO2 48, HCO3 26 and pO2 91 on 2 L/min of oxygen per nasal cannula. Which of the following interventions has the highest priority? a. Increase the client's O2 delivery to 4 L/min. b. Administer an anti-anxiety agent to calm the client. c. Assist the client to deep breathe, splinting with a pillow. d. Notify the health care provider of the abnormal ABG's.

c. Assist the client to deep breathe, splinting with a pillow. The client's pO2 is normal and while increasing available O2 may help, it does not correct the problem of hypoventilation.

The following clients have been assessed in the emergency department. Which of the following clients requires immediate attention? a. A 6 year-old client with an open tibial fracture that occurred two hours ago after being hit by a car. b. An 81 year-old client with a history of heart failure and new onset pneumonia with a respiratory rate of 32 and a temp of 101 F (38). c. A 19 year-old client who is vomiting and complaining of new onset right lower quadrant pain with rebound tenderness. d. A 48 year-old male complaining of chest pain, cardiac monitor showing sinus tachycardia with occasional PVC's.

d. A 48 year-old male complaining of chest pain, cardiac monitor showing sinus tachycardia with occasional PVC's. While all of these clients require nursing care, the 48 year-old male with c/o chest pain and a cardiac rhythm of sinus tachycardia with occasional PVC's needs immediate attention! Chest pain is an indication of myocardial ischemia and this client has other factors that put him at risk for sudden death: gender, age and PVC's. PVC's are not normal in a 48 year old. PVC's occur when the myocardium is irritated, usually from hypoxia but also from electrolyte imbalance, usually involving K+. This client is young and as a result has not had sufficient time to develop adequate collateral circulation.

A health care professional should conclude that alosetron therapy is effective when a patient who is taking it reports which of the following? A. One formed stool per day B. Urination without burning C. No nausea or vomiting D. Less GI reflux

A. One formed stool per day ondansetron is for nausea and vomiting alosetron treats the diarrhea and pain of severe irritable bowel syndrome.

A primary care provider should use caution when prescribing bisacodyl for a patient who has A. anorexia nervosa B. myelosuppression C. hypomagnesemia D. diabetes mellitus

A. anorexia nervosa Bisacodyl, a stimulant laxative, requires caution with patients who have an eating disorder because of the risk of laxative abuse

A primary care provider should use caution when prescribing sulfasalazine for a patient who has: A. pancreatitis B. aspirin sensitivity C. bronchitis D. GERD

B. aspirin sensitivity Any sensitivity to salicylates, sulfonamides, or trimethoprim is a contraindication for the use of sulfasalazine

A health care professional is caring for a male patient who has hyperthyroidism that has not responded to treatment. The health care professional should recognize that this thyroid disorder is a contraindication for which of the following genitourinary-system drugs? A. sildenafil B. bethanechol C. tamsulosin D. finasteride

B. bethanechol Bethanechol, a cholinergic drug, can cause cardiac dysrhythmias in patients who have hyperthyroidism because it can trigger the release of norepinephrine, which can induce dysrhythmias. This reaction does not occur in patients who do not have hyperthyroidism.