75 NCLEX QUESTIONS WITH CORRECT
ANSWERS
The nurse is taking the health history of a patient being treated for Emphysema and Chronic B
ronchitis. Aſter being told the patient has been smoking cigarettes for 30 years, the nurse exp
ects to note which assessment finding?
1. Increase in Forced Vital Capacity (FVC)
2. A narrowed chest cavity
3. Clubbed fingers
4. An increased risk of cardiac failure - CORRECT ANSWER -
1. Increase in Forced Vital Capacity (FVC)
Forced Vital Capacity is the volume of air exhaled from full inhalation to full exhalation. A pati
ent with COPD would have a decrease in FVC. Incorrect.
2. A narrowed chest cavity
A patient with COPD oſten presents with a 'barrel chest,' which is seen as a widened chest cav
ity. Incorrect.
3. Clubbed fingers - CORRECT
Clubbed fingers are a sign of a long-term, or chronic, decrease in oxygen levels.
4. An increased risk of cardiac failure
Although a patient with these conditions would indeed be at an increased risk for cardiac failu
re, this is a potential complication and not an assessment finding. Incorrect.
,The nurse is taking the health history of a 70-year-
old patient being treated for a Duodenal Ulcer. Aſter being told the patient is complaining of e
pigastric pain, the nurse expects to note which assessment finding?
1. Melena
2. Nausea
3. Hernia
4. Hyperthermia - CORRECT ANSWER -1. Melena - CORRECT
Melena is the finding that there are traces of blood in the stool which presents as black, tarry
feces. This is a common manifestation of Duodenal Ulcers, since the Duodenum is further dow
n the gastric anatomy.
2. Nausea
Nausea may be present, but is a generalized symptom and by itself doesn't indicate a Duoden
al Ulcer. Incorrect.
3. Hernia
A Hernia is a protrusion of a segment of the abdomen through another abdominal structure. I
t is not associated with an Ulcer and is a condition, not an assessment finding. Incorrect.
4. Hyperthermia
Hyperthermia, a highxtemperature,x isxnotxanxassessmentxfindingxofxaxDuodenalx Ulcer.x Incorrect
Axnursex isxprovidingx dischargex teachingxforx axpatientxwithx severex Gastroesophogealx RefluxxDis
e
ase.xWhichxofxthesexstatementsxbyxthexpatientxindicatesx axneedxforx morexteaching?
1.x"I'mxgoingxtox limitxmyx mealsxtox2-
3xperx dayx tox reducex acidxsecretion."
,x
2.x"I'mxgoingxtox makex surextoxremainxuprightxaſterx mealsxandxelevatex myx headx whenx Ixsleep
"
3
.x"Ix won'txbexdrinkingxteax orxcoffeex orxeatingxchocolatex anyxmore."
4.x"I'mxgoingxtox startxtryingxtox losexsomex weight."x-xCORRECTx ANSWERx-
1.x"I'mxgoingxtox limitxmyx mealsxtox2-
3xperx dayx tox reducex acidxsecretion."
CORRECTx -
Largex mealsxincreasexthex volumexandx pressurexinx thexstomachx andxdelayxgastricx emptying.xIt'
s
recommendedx insteadxtox eatx4-6xsmallxmealsxaxday.
2.x"I'mxgoingxtox makex surextoxremainxuprightxaſterx mealsxandxelevatex myx headx whenx Ixsleep
"
Incorrectx-xThisxisxax correctxverbalizationxofx healthxpromotionxforx GERD.
3.x"Ix won'txbexdrinkingxteax orxcoffeex orxeatingxchocolatex anyxmore.
"
Incorrectx-xThisxisxax correctxverbalizationxofx healthxpromotionxforx GERD.
4.x"I'mxgoingxtox startxtryingxtox losexsomex weight."
Incorrectx-xThisxisxax correctxverbalizationxofx healthxpromotionxforx GERD.
Thexnursex inxthexEmergencyxRoomx isxtreatingxaxpatientxsuspectedxtox havexaxPepticxUlcer.x Onx a
s
sessingxlabxresults,xthexnursex findsxthatxthexpatient'sxbloodxpressurex isx95/60,x pulsexisx110xbea
t
sxperxminute,xandx thexpatientxreportsxepigastricxpain.xWhatxisxthexPRIORITYx intervention?
1.xStartxaxlarge-borex IVxinx thexpatient'sxarm
2.xAskxthexpatientxforx axstoolx sample
3.xPreparextox insertxanxNGx Tube
4.xAdministerxintramuscularx morphinex sulphatexasxorderedx -xCORRECTx ANSWERx-
1.xStartxaxlarge-borex IVxinx thexpatient'sxarm
,x
CORRECTx -
Thexnursex shouldxsuspectxthatx thexpatientxisxhaemorrhagingxandx willxneedx needx axfluidx repla
c
ementxtherapy,x whichxrequiresx axlargex borex IV.
2.xAskxthexpatientxforx axstoolx sample
Incorrectx-
Whilexthisxisxusefulxinxthex diagnosisxandx assessmentxofxPepticxUlcerxDisease,x itxisxnotxthexpri
or
ityxintervention.
3.xPreparextox insertxanxNGx Tube
Incorrectx-
Whilexthisxinterventionxmayx bexusedxinx thexlaterxstagesx ofxPepticxUlcerxDisease,xitxisxnotxthex
fir
stx andxpriorityxintervention.
4.xAdministerxintramuscularx morphinex sulphatexasxordered
Incorrectx-
Whilexthisxisxanximportantxinterventionxtoxmanagex pain,xitxisxnotxthexpriorityxintervention
.
Axfemalexpatientxwithx atrialx fibrillationxhasxthexfollowingx labxresults:xHemoglobinxofx11x g/dl,xa
plateletxcountxofx150,000,x anxINRxofx2.5,xandx potassiumx ofx2.7xmEq/L.xWhichx resultxisxcriticalx
a
ndxshouldxbexreportedx tox thexphysicianx immediately?
1.xHemoglobinx 11xg/dl
2.xPlateletxofx150,000
3.xINRxofx2.5
4.xPotassiumxofx 2.7xmEq/Lx -xCORRECTx ANSWERx-1.xHemoglobinx 11xg/dl
Thisxisxbelowxnormal,xbutxaxnormalxfemalexhemoglobinx isx12-
14.xTherex isxaxmorex criticalxlabxresult.
ANSWERS
The nurse is taking the health history of a patient being treated for Emphysema and Chronic B
ronchitis. Aſter being told the patient has been smoking cigarettes for 30 years, the nurse exp
ects to note which assessment finding?
1. Increase in Forced Vital Capacity (FVC)
2. A narrowed chest cavity
3. Clubbed fingers
4. An increased risk of cardiac failure - CORRECT ANSWER -
1. Increase in Forced Vital Capacity (FVC)
Forced Vital Capacity is the volume of air exhaled from full inhalation to full exhalation. A pati
ent with COPD would have a decrease in FVC. Incorrect.
2. A narrowed chest cavity
A patient with COPD oſten presents with a 'barrel chest,' which is seen as a widened chest cav
ity. Incorrect.
3. Clubbed fingers - CORRECT
Clubbed fingers are a sign of a long-term, or chronic, decrease in oxygen levels.
4. An increased risk of cardiac failure
Although a patient with these conditions would indeed be at an increased risk for cardiac failu
re, this is a potential complication and not an assessment finding. Incorrect.
,The nurse is taking the health history of a 70-year-
old patient being treated for a Duodenal Ulcer. Aſter being told the patient is complaining of e
pigastric pain, the nurse expects to note which assessment finding?
1. Melena
2. Nausea
3. Hernia
4. Hyperthermia - CORRECT ANSWER -1. Melena - CORRECT
Melena is the finding that there are traces of blood in the stool which presents as black, tarry
feces. This is a common manifestation of Duodenal Ulcers, since the Duodenum is further dow
n the gastric anatomy.
2. Nausea
Nausea may be present, but is a generalized symptom and by itself doesn't indicate a Duoden
al Ulcer. Incorrect.
3. Hernia
A Hernia is a protrusion of a segment of the abdomen through another abdominal structure. I
t is not associated with an Ulcer and is a condition, not an assessment finding. Incorrect.
4. Hyperthermia
Hyperthermia, a highxtemperature,x isxnotxanxassessmentxfindingxofxaxDuodenalx Ulcer.x Incorrect
Axnursex isxprovidingx dischargex teachingxforx axpatientxwithx severex Gastroesophogealx RefluxxDis
e
ase.xWhichxofxthesexstatementsxbyxthexpatientxindicatesx axneedxforx morexteaching?
1.x"I'mxgoingxtox limitxmyx mealsxtox2-
3xperx dayx tox reducex acidxsecretion."
,x
2.x"I'mxgoingxtox makex surextoxremainxuprightxaſterx mealsxandxelevatex myx headx whenx Ixsleep
"
3
.x"Ix won'txbexdrinkingxteax orxcoffeex orxeatingxchocolatex anyxmore."
4.x"I'mxgoingxtox startxtryingxtox losexsomex weight."x-xCORRECTx ANSWERx-
1.x"I'mxgoingxtox limitxmyx mealsxtox2-
3xperx dayx tox reducex acidxsecretion."
CORRECTx -
Largex mealsxincreasexthex volumexandx pressurexinx thexstomachx andxdelayxgastricx emptying.xIt'
s
recommendedx insteadxtox eatx4-6xsmallxmealsxaxday.
2.x"I'mxgoingxtox makex surextoxremainxuprightxaſterx mealsxandxelevatex myx headx whenx Ixsleep
"
Incorrectx-xThisxisxax correctxverbalizationxofx healthxpromotionxforx GERD.
3.x"Ix won'txbexdrinkingxteax orxcoffeex orxeatingxchocolatex anyxmore.
"
Incorrectx-xThisxisxax correctxverbalizationxofx healthxpromotionxforx GERD.
4.x"I'mxgoingxtox startxtryingxtox losexsomex weight."
Incorrectx-xThisxisxax correctxverbalizationxofx healthxpromotionxforx GERD.
Thexnursex inxthexEmergencyxRoomx isxtreatingxaxpatientxsuspectedxtox havexaxPepticxUlcer.x Onx a
s
sessingxlabxresults,xthexnursex findsxthatxthexpatient'sxbloodxpressurex isx95/60,x pulsexisx110xbea
t
sxperxminute,xandx thexpatientxreportsxepigastricxpain.xWhatxisxthexPRIORITYx intervention?
1.xStartxaxlarge-borex IVxinx thexpatient'sxarm
2.xAskxthexpatientxforx axstoolx sample
3.xPreparextox insertxanxNGx Tube
4.xAdministerxintramuscularx morphinex sulphatexasxorderedx -xCORRECTx ANSWERx-
1.xStartxaxlarge-borex IVxinx thexpatient'sxarm
,x
CORRECTx -
Thexnursex shouldxsuspectxthatx thexpatientxisxhaemorrhagingxandx willxneedx needx axfluidx repla
c
ementxtherapy,x whichxrequiresx axlargex borex IV.
2.xAskxthexpatientxforx axstoolx sample
Incorrectx-
Whilexthisxisxusefulxinxthex diagnosisxandx assessmentxofxPepticxUlcerxDisease,x itxisxnotxthexpri
or
ityxintervention.
3.xPreparextox insertxanxNGx Tube
Incorrectx-
Whilexthisxinterventionxmayx bexusedxinx thexlaterxstagesx ofxPepticxUlcerxDisease,xitxisxnotxthex
fir
stx andxpriorityxintervention.
4.xAdministerxintramuscularx morphinex sulphatexasxordered
Incorrectx-
Whilexthisxisxanximportantxinterventionxtoxmanagex pain,xitxisxnotxthexpriorityxintervention
.
Axfemalexpatientxwithx atrialx fibrillationxhasxthexfollowingx labxresults:xHemoglobinxofx11x g/dl,xa
plateletxcountxofx150,000,x anxINRxofx2.5,xandx potassiumx ofx2.7xmEq/L.xWhichx resultxisxcriticalx
a
ndxshouldxbexreportedx tox thexphysicianx immediately?
1.xHemoglobinx 11xg/dl
2.xPlateletxofx150,000
3.xINRxofx2.5
4.xPotassiumxofx 2.7xmEq/Lx -xCORRECTx ANSWERx-1.xHemoglobinx 11xg/dl
Thisxisxbelowxnormal,xbutxaxnormalxfemalexhemoglobinx isx12-
14.xTherex isxaxmorex criticalxlabxresult.
