Practice Test Qs & Topics for NCLEX

Guillain-Barré syndrome

Guillain-Barré is a neuromuscular disorder in which the client may experience weakening or paralysis of the muscles used for respiration. This could cause the client to retain carbon dioxide, leading to respiratory acidosis and ventilatory failure as the paralysis develops.

The nurse is obtaining the intershift report for a group of assigned clients. Which of the following assigned clients should the nurse monitor closely for signs of hyperkalemia?

A client admitted 6 hours ago with a 40% burn injury. Rationale: Hyperkalemia is likely to occur in clients who experience cellular shifting of potassium caused by early massive cell destruction, such as in trauma or burns. Other clients at risk for hyperkalemia are those with sepsis or metabolic or respiratory acidosis (with the exception of diabetic acidosis). Clients with Cushing's syndrome, ulcerative colitis, or those using laxatives excessively are at risk for hypokalemia.

The nurse overhears the physician stating that the client who is in hypovolemic shock requires plasma expansion. The nurse anticipates that the physician will write a prescription to transfuse what blood product to this client?

Albumin, may be used as a plasma expander in hypovolemia with or without shock. Cryoprecipitate is useful in treating bleeding from hemophilia or disseminated intravascular coagulopathy because it is rich in clotting factors. Packed red blood cells replace erythrocytes and are not a plasma expander. Platelets are used when the client's platelet count is low, typically below 20,000/mm3.

A unit of packed red blood cells (PRBCs) was just received from the blood bank for transfusion to an assigned client. The nurse is careful to select tubing especially made for blood products, knowing that this tubing is manufactured with which of the following features?

An in-line filter. Rationale: The tubing used for blood administration has an in-line filter. This helps ensure that any particles larger than the size of the filter are caught in the filter and are not infused into the client. The tubing should be macrodrip, not microdrip, to allow blood to flow freely through the drip chamber. An air vent is unnecessary because the blood bag is not made of glass. "Tinted tubing to protect the blood from light" is incorrect; blood does not need to be protected from light.

The nurse is providing directions to a client about how to test a stool for occult blood. The nurse cautions that the presence of what could cause a false-negative result?

Ascorbic acid. Rationale: Ascorbic acid can interfere with results of occult blood testing, yielding a false-negative result. ** Colchicine and iodine can cause false-positive results.

The nurse is reviewing the physician's prescription sheet for the preoperative client, which states that the client must be NPO after midnight. The nurse should clarify what type of medication should be given to the client and not withheld?

Atenolol (or any beta-blocker). Rationale: Atenolol is a beta blocker. Beta blockers should not be stopped abruptly, and the physician should be contacted about the administration of this medication prior to surgery. If a beta blocker is stopped abruptly, the myocardial need for oxygen is increased. Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia. Conjugated estrogen (Premarin) is an estrogen used for hormone replacement therapy in postmenopausal women. The other three medications may be withheld before surgery without undue effects on the client.

Bumetanide (Bumex)

Bumetanide (Bumex) is a loop diuretic that places the client at risk for hypokalemia. The nurse would monitor this client carefully for signs of hypokalemia, monitor serum potassium levels, and encourage intake of high-potassium foods.

The nurse is caring for a client with Paget's disease who has an elevated serum calcium level of 12.3 mEq/L. The nurse checks to see that which of the following medications is available in the stock medication supply for possible use to reverse this elevation?

Calcitonin. Rationale: The normal serum calcium level is 4.5 to 5.5 mEq/L or 9 to 11 mg/dL. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones, thus keeping it out of the serum. In hypercalcemia, large doses of vitamin D should be avoided. Calcium gluconate and calcium chloride would be used to treat tetany that results from acute hypocalcemia.

The nurse is assisting in monitoring a client who is receiving a transfusion of packed red blood cells (PRBCs). Before leaving the room, the nurse tells the client that it is most important to immediately report which of the following symptoms of a transfusion reaction, if they occur?

Chest pain, Chills, Difficulty breathing, Low back pain. Rationale: The nurse should instruct the client to immediately report signs of a transfusion reaction, which can include chest pain, lower back pain, chills, itching, rash, or difficulty breathing. These signs of transfusion reaction would require the nurse to stop the transfusion. Fatigue and sleepiness are unrelated to transfusion reaction.

The nurse is caring for a group of clients on the clinical nursing unit. Which of the following clients should the nurse plan to monitor for signs of fluid volume deficit?

Client with an ileostomy. Rationale: The client with an ileostomy is at risk for fluid volume deficit caused by increased gastrointestinal (GI) tract losses. Other causes of fluid volume deficit include vomiting, diarrhea, conditions that cause increased respiratory rate or urine output, insufficient IV fluid replacement, draining fistulas, and the presence of an ileostomy or colostomy. Clients who have heart failure or renal failure are at risk for fluid volume excess. Hypertension is unrelated to the subject of the question. Test-Taking Strategy: Focus on the strategic words "fluid volume deficit." Read each option, considering the fluid imbalance that can occur in each. Eliminate "client in acute renal failure" and "client in congestive heart failure" first because these clients would be more likely to retain fluid than to lose it. Choose correctly between the remaining two options, keeping in mind the liquid nature of ileostomy drainage. If you had difficulty with this question, review the causes of fluid volume deficit.

A client is determined to be in respiratory alkalosis by blood gas analysis. The nurse would monitor this client for signs of what electrolyte disorders that could accompany the acid-base imbalance?

Hypokalemia. Rationale: Clinical manifestations of respiratory alkalosis include tachypnea, hyperpnea, weakness, paresthesias, tetany, dizziness, convulsions, coma, hypokalemia, and hypocalcemia.

The client with diabetes mellitus has a blood glucose level on admission of 596 mg/dL. The nurse anticipates that this client would be experiencing which of the following types of acid-base imbalance?

Metabolic acidosis. Rationale: Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating insulin, the blood glucose level rises while the cells of the body use all available glucose and then break down glycogen and fat for fuel. The by-products of fat metabolism are acidotic, leading to the complication called diabetic ketoacidosis.

A client has been diagnosed with metabolic alkalosis as a result of excessive antacid use. The nurse should monitor this client, expecting to note which of the following signs and symptoms?

Decreased respiratory rate and depth. Rationale: The client with metabolic alkalosis is likely to exhibit decreased respiratory rate and depth as a compensatory mechanism. The client with metabolic acidosis would display the symptoms noted in "drowsiness, headache, and tachypnea." The client with respiratory acidosis and alkalosis would display the symptoms noted in "disorientation and dyspnea" and "tachypnea, dizziness, and paresthesias" respectively.

Digoxin

Digoxin is derived from the leaves of a digitalis plant. Digoxin helps make the heart beat stronger and with a more regular rhythm. Digoxin is used to treat heart failure, also used to treat atrial fibrillation, a heart rhythm disorder of the atria. Try to take the medication at the same time every day. Do not d/c digoxin abruptly. Therapeutic Range: 0.8 to 2.0 ng/ml Steady state: 7- 10 days (possibly longer). Toxic level: >2.4 ng/ml Half-life: 33 - 51 hours. Obtaining levels: determine serum digoxin levels at least 4 hours after an IV dose or 6 hours after an oral dose in order to allow sufficient time for drug distribution.

The nurse is caring for a client who overdosed on acetylsalicylic acid (aspirin) 24 hours ago. The nurse expects to note which of the following findings associated with an anticipated acid-base disturbance?

Drowsiness, headache, and tachypnea. Rationale: The client who ingests a large amount of acetylsalicylic acid (aspirin) is at risk for developing metabolic acidosis 24 hours later. If metabolic acidosis occurs, the client is likely to exhibit drowsiness, headache, and tachypnea. In the very early hours following aspirin overdose, the client may exhibit respiratory alkalosis as a compensatory mechanism. However, by 24 hours postoverdose, the compensatory mechanism fails and the client reverts to metabolic acidosis. The client with metabolic alkalosis ("decreased respiratory rate and depth, cardiac irregularities") is likely to experience cardiac irregularities and a compensatory decreased respiratory rate and depth. "Disorientation and dyspnea" and "tachypnea, dizziness, and paresthesias" indicate respiratory acidosis and alkalosis, respectively.

Third-spacing

Fluid that shifts into the interstitial spaces and remains there is referred to as third-space fluid. This fluid is physiologically useless because it does not circulate to provide nutrients for the cells. Common sites for third-spacing include the pleural and peritoneal cavities and pericardial sac. Risk factors include older adults and those with liver or kidney disease, major trauma, burns, sepsis, major surgery, malignancy, gastrointestinal (GI) malabsorption, and malnutrition. The client who has suffered a stroke is not at risk for third-spacing.

What has the lowest amt of K+? Apple, raw spinach, carrot, avocado

One medium apple with skin provides approximately 159 mg of potassium per serving, so it has the lowest potassium content of these choices. Raw spinach (oz) provides 470 mg of potassium. One large carrot has 341 mg of potassium. One medium avocado provides the highest potassium content, 1097 mg.

A client is being treated for metabolic acidosis with medication therapy and other measures. The nurse would plan to most carefully note the results of which of the following electrolytes, which could dramatically decline with effective treatment of the acidosis?

Potassium. Rationale: The serum potassium level tends to rise with metabolic acidosis. This is because potassium moves out of the cells and into the bloodstream. When acidosis is corrected with treatment, the potassium will shift back into the cellular compartment. This can cause a rapid drop in the serum potassium level. Because of the effects of potassium on the heart, this electrolyte should be monitored closely while the client is treated. Test-Taking Strategy: Specific knowledge about electrolyte changes that accompany acid-base disturbances is needed to answer the question. In the question, note the strategic words "most carefully" which tell you that more than one option may be partially correct. Recall the roles of the various electrolytes in the body to select the correct option. Remember that the serum potassium level tends to rise with metabolic acidosis. Review metabolic acidosis if you had difficulty with this question.

CSF lvls

Protein (15 to 45 mg/dL) and glucose (50 to 75 mg/dL) normally are present in CSF. Normal CSF has no red blood cells in the CSF, possibly a small numbers of white blood cells (0 to 5 cells/mm3).

The nurse is caring for a client who is experiencing metabolic alkalosis. The nurse plans to protect the client's safety, knowing the risks of this imbalance, by carefully implementing what prescribed precautions?

Seizure precautions. Rationale: The client with metabolic alkalosis is at risk for tetany and seizures. The nurse would maintain client safety by using seizure precautions with this client.

S/Sx of hypermagnesemia and hypomagnesemia

Signs of hypermagnesemia include neurological depression, drowsiness and lethargy, loss of deep tendon reflexes (areflexia), respiratory paralysis, and loss of consciousness. Tetany, muscular excitability, and tremors are seen with hypomagnesemia.

S/Sx of hypocalcemia

Signs of hypocalcemia include tingling sensations, hyperactive reflexes, and a positive Trousseau or Chvostek sign. Other signs include increased neuromuscular excitability, muscle cramps, tetany, seizures, insomnia, irritability, memory impairment, and anxiety. ** Severe muscle weakness is seen in hypercalcemia not hypocalcemia.

The most common complication associated with parenteral nutrition (PN)?

The most common complication associated with PN is infection. Monitoring the temperature would provide data that would indicate infection in the client. Monitoring the serum BUN level would not provide information related to infection and is most closely related to assessing renal function. Weighing the client daily and monitoring I&O would provide information related to fluid volume overload.

serum potassium

The normal serum potassium level in the adult is 3.5 to 5.1 mEq/L ("5.1 mEq/L," "4.2 mEq/L," and "3.8 mEq/L"). "3.0 mEq/L" indicates a low value. Administering furosemide to a client with a low potassium level and a history of cardiovascular disease could precipitate cardiac dysrhythmias in the client

digoxin (Lanoxin)

The normal therapeutic range for digoxin is 0.5 to 2.0 ng/mL. A value of 2.7 ng/mL exceeds the therapeutic range and could be toxic to the client. The nurse should gather data about signs of digoxin toxicity and then notify the health care provider.

serum phenytoin levels

The therapeutic range for serum phenytoin (Dilantin) level is 10 to 20 mcg/mL. If the level is below the therapeutic range, the client could experience seizure activity. If the level is too high, the client is at risk for phenytoin toxicity.

serum theophylline (or aminophylline)

The therapeutic range for serum theophylline (or aminophylline) level is 10 to 20 mcg/mL. If the level is within the therapeutic range, the client is most likely compliant with medication therapy. If the level is below the therapeutic range, the client may not be compliant with medication therapy and is at risk for more frequent exacerbations of the disease. Reference ranges of theophylline in the treatment asthma vary by age, as follows: Adults: 5-15 µg/mL, Children: 5-10 µg/mL The reference range of theophylline in the treatment of acute bronchospasm in adults is 10-15 µg/mL.