NUR 101 NCLEX PRACTISE EXAM 4 ( 50 ITEMS )
NCLEX Practice Exam 4 (50 Items)
Question 1
The primary reason for rapid continuous rewarming of the area affected by frostbite is to:
Lessen the amount of cellular damage
Prevent the formation of blisters
Promote movement
Prevent pain and discomfort
Question 1 Explanation:
Rapid continuous rewarming of a frostbite primarily lessens cellular damage. Options B, C, and D:
Rewarming of a frosbite does not prevent the formation of blisters. It does promote movement, but this
is not the primary reason for rapid rewarming. It might increase pain for a short period of time as the
feeling comes back into the extremity.
Question 2
A client recently started on hemodialysis wants to know how the dialysis will take the place of his kidneys.
The nurse’s response is based on the knowledge that hemodialysis works by:
Passing water through a dialyzing membrane
Eliminating plasma proteins from the blood
Lowering the pH by removing nonvolatile acids
Filtering waste through a dialyzing membrane
Question 2 Explanation:
Hemodialysis works by using a dialyzing membrane to filter waste that has accumulated in the blood.
Options A, B, and C: Hemodialysis does not pass water through a dialyzing membrane nor does it
eliminate plasma proteins or lower the pH.
Question 3
,During a home visit, a client with AIDS tells the nurse that he has been exposed to measles. Which action
by the nurse is most appropriate?
Administer an antibiotic
Contact the physician for an order for immune globulin
Administer an antiviral
Tell the client that he should remain in isolation for 2 weeks
Question 3 Explanation:
The client who is immunosuppressed and is exposed to measles should be treated with medications to
boost his immunity to the virus. Options A, C, and D: An antibiotic or antiviral will not protect the client
and it is too late to place the client in isolation.
Question 4
A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on contact precautions.
Which statement is true regarding precautions for infections spread by contact?
The client should be placed in a room with negative pressure.
Infection requires close contact; therefore, the door may remain
open.
Transmission is highly likely, so the client should wear a mask at
all times.
Infection requires skin-to-skin contact and is prevented by hand
washing, gloves, and a gown.
Question 4 Explanation:
The client with MRSA should be placed in isolation. Gloves, a gown, and a mask should be used when
caring for the client and hand washing is very important. Options A and B: The door should remain
closed, but a negative-pressure room is not necessary. Option C: MRSA is spread by contact with blood or
body fluid or by touching the skin of the client. It is cultured from the nasal passages of the client, so the
client should be instructed to cover his nose and mouth when he sneezes or coughs. It is not necessary
for the client to wear the mask at all times; the nurse should wear the mask.
Question 5
, A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches.
Which response by the nurse indicates understanding of phantom limb pain?
“The pain will go away in a few days.”
“The pain is due to peripheral nervous system interruptions. I
will get you some pain medication.”
“The pain is psychological because your foot is no longer there.”
“The pain and itching are due to the infection you had before the
surgery.”
Question 5 Explanation:
Pain related to phantom limb syndrome is due to peripheral nervous system interruption. Option A is
incorrect because phantom limb pain can last several months or indefinitely. Option C is incorrect
because it is not psychological. Option D: It is also not due to infections.
Question 6
A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during
the Whipple procedure, the doctor will remove the:
Head of the pancreas
Proximal third section of the small intestines
Stomach and duodenum
Esophagus and jejunum
Question 6 Explanation:
During a Whipple procedure the head of the pancreas, which is a part of the stomach, the jejunum, and a
portion of the stomach are removed and anastomosed. Answer B is incorrect because the proximal third
of the small intestine is not removed. The entire stomach is not removed, as in answer C, and in answer
D, the esophagus is not removed.
Question 7
The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be
taught to avoid eating:
NCLEX Practice Exam 4 (50 Items)
Question 1
The primary reason for rapid continuous rewarming of the area affected by frostbite is to:
Lessen the amount of cellular damage
Prevent the formation of blisters
Promote movement
Prevent pain and discomfort
Question 1 Explanation:
Rapid continuous rewarming of a frostbite primarily lessens cellular damage. Options B, C, and D:
Rewarming of a frosbite does not prevent the formation of blisters. It does promote movement, but this
is not the primary reason for rapid rewarming. It might increase pain for a short period of time as the
feeling comes back into the extremity.
Question 2
A client recently started on hemodialysis wants to know how the dialysis will take the place of his kidneys.
The nurse’s response is based on the knowledge that hemodialysis works by:
Passing water through a dialyzing membrane
Eliminating plasma proteins from the blood
Lowering the pH by removing nonvolatile acids
Filtering waste through a dialyzing membrane
Question 2 Explanation:
Hemodialysis works by using a dialyzing membrane to filter waste that has accumulated in the blood.
Options A, B, and C: Hemodialysis does not pass water through a dialyzing membrane nor does it
eliminate plasma proteins or lower the pH.
Question 3
,During a home visit, a client with AIDS tells the nurse that he has been exposed to measles. Which action
by the nurse is most appropriate?
Administer an antibiotic
Contact the physician for an order for immune globulin
Administer an antiviral
Tell the client that he should remain in isolation for 2 weeks
Question 3 Explanation:
The client who is immunosuppressed and is exposed to measles should be treated with medications to
boost his immunity to the virus. Options A, C, and D: An antibiotic or antiviral will not protect the client
and it is too late to place the client in isolation.
Question 4
A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on contact precautions.
Which statement is true regarding precautions for infections spread by contact?
The client should be placed in a room with negative pressure.
Infection requires close contact; therefore, the door may remain
open.
Transmission is highly likely, so the client should wear a mask at
all times.
Infection requires skin-to-skin contact and is prevented by hand
washing, gloves, and a gown.
Question 4 Explanation:
The client with MRSA should be placed in isolation. Gloves, a gown, and a mask should be used when
caring for the client and hand washing is very important. Options A and B: The door should remain
closed, but a negative-pressure room is not necessary. Option C: MRSA is spread by contact with blood or
body fluid or by touching the skin of the client. It is cultured from the nasal passages of the client, so the
client should be instructed to cover his nose and mouth when he sneezes or coughs. It is not necessary
for the client to wear the mask at all times; the nurse should wear the mask.
Question 5
, A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches.
Which response by the nurse indicates understanding of phantom limb pain?
“The pain will go away in a few days.”
“The pain is due to peripheral nervous system interruptions. I
will get you some pain medication.”
“The pain is psychological because your foot is no longer there.”
“The pain and itching are due to the infection you had before the
surgery.”
Question 5 Explanation:
Pain related to phantom limb syndrome is due to peripheral nervous system interruption. Option A is
incorrect because phantom limb pain can last several months or indefinitely. Option C is incorrect
because it is not psychological. Option D: It is also not due to infections.
Question 6
A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during
the Whipple procedure, the doctor will remove the:
Head of the pancreas
Proximal third section of the small intestines
Stomach and duodenum
Esophagus and jejunum
Question 6 Explanation:
During a Whipple procedure the head of the pancreas, which is a part of the stomach, the jejunum, and a
portion of the stomach are removed and anastomosed. Answer B is incorrect because the proximal third
of the small intestine is not removed. The entire stomach is not removed, as in answer C, and in answer
D, the esophagus is not removed.
Question 7
The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be
taught to avoid eating:
