Comprehensive NCLEX-RN| Quiz #6: (75 Questions and Correct Answers/ Rationale (2022 update)

Comprehensive NCLEX-RN| Quiz #6: (75 Questions and Correct Answers/ Rationale (2022 update) 1. Question Category: Reduction of Risk Potential After cardiac surgery, a client’s blood pressure measures 126/80 mm Hg. Nurse Katrina determines that mean arterial pressure (MAP) is which of the following? 2. Question Category: Physiological Adaptation A female client arrives at the emergency department with chest and stomach pain and a report of black tarry stool for several months. Which of the following orders should the nurse Oliver anticipate? 3. Question Olivia had coronary artery bypass graft (CABG) surgery 3 days ago. Which of the following conditions is suspected by the nurse when a decrease in platelet count from 230,000 ul to 5,000 ul is noted? 4. Question Category: Pharmacological and Parenteral Therapies Which of the following drugs would be ordered by the physician to improve the platelet count in a male client with idiopathic thrombocytopenic purpura (ITP)? 5. Question Category: Reduction of Risk Potential A female client is scheduled to receive a heart valve replacement with a porcine valve. Which of the following types of transplant is this? 6. Question Category: Physiological Adaptation Marco falls off his bicycle and injures his ankle. Which of the following actions shows the initial response to the injury in the extrinsic pathway? 7. Question Category: Physiological Adaptation Instructions for a client with systemic lupus erythematosus (SLE) would include information about which of the following blood dyscrasias? 8. Question Category: Reduction of Risk Potential The nurse is aware that the following symptom is most commonly an early indication of stage 1 Hodgkin’s disease? 9. Question Category: Reduction of Risk Potential Francis with leukemia has neutropenia. Which of the following functions must be frequently assessed? 10. Question Category: Physiological Adaptation The nurse knows that neurologic complications of multiple myeloma (MM) usually involve which of the following body systems? 11. Question Category: Physiological Adaptation Nurse Patricia is aware that the average length of time from human immunodeficiency virus (HIV) infection to the development of acquired immunodeficiency syndrome (AIDS)? 12. Question Category: Reduction of Risk Potential An 18-year-old male client admitted with heat stroke begins to show signs of disseminated intravascular coagulation (DIC). Which of the following laboratory findings is most consistent with DIC? 13. Question Category: Physiological Adaptation Mario comes to the clinic complaining of fever, drenching night sweats, and unexplained weight loss over the past 3 months. Physical examination reveals a single enlarged supraclavicular lymph node. Which of the following is the most probable diagnosis? 14. Question Category: Physiological Adaptation A male client with a gunshot wound requires an emergency blood transfusion. His blood type is AB negative. Which blood type would be the safest for him to receive? 15. Question Category: Health Promotion and Maintenance Stacy was diagnosed with acute lymphoid leukemia (ALL). She was discharged from the hospital following her chemotherapy treatments. Which statement of Stacy’s mother indicated that she understands when she will contact the physician? 16. Question Category: Psychosocial Integrity Molly Sue is diagnosed with acute lymphoid leukemia (ALL) and beginning chemotherapy. Her mother states to the nurse that it is hard to see Molly Sue with no hair. The best response for the nurse is: 17. Question Category: Basic Care and Comfort Brittany who is undergoing chemotherapy for her throat cancer is experiencing stomatitis. To promote oral hygiene and comfort, the nurse-in-charge should: Provide frequent mouthwash with normal saline. 18. Question Category: Management of Care During the administration of chemotherapy agents, Nurse Oliver observed that the IV site is red and swollen when the IV is touched Stacy shouts in pain. The first nursing action to take is: 19. Question Category: Physiological Adaptation The term “blue bloater” refers to a male client which of the following conditions? 20. Question Category: Physiological Adaptation The term “pink puffer” refers to the female client with which of the following conditions? 21. Question Category: Reduction of Risk Potential Jose is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. Nurse Oliver would expect the paco2 to be which of the following values? 22. Question Category: Reduction of Risk Potential Timothy’s arterial blood gas (ABG) results are as follows; pH 7.16; Paco2 80 mm Hg; Pao2 46 mm Hg; HCO3- 24 mEq/L; Sao2 81%. This ABG result represents which of the following conditions? 23. Question Category: Physiological Adaptation Norma has started a new drug for hypertension. Thirty minutes after she takes the drug, she develops chest tightness and becomes short of breath and tachypnea. She has a decreased level of consciousness. These signs indicate which of the following conditions? 24. Question Category: Reduction of Risk Potential Mr. Gonzales was admitted to the hospital with ascites and jaundice. To rule out cirrhosis of the liver which laboratory test indicates liver cirrhosis? 25. Question Category: Reduction of Risk Potential The biopsy of Mr. Gonzales confirms the diagnosis of cirrhosis. Mr. Gonzales is at increased risk for excessive bleeding primarily because of: 26. Question Category: Physiological Adaptation Mr. Jay develops hepatic encephalopathy. Which clinical manifestation is most common with this condition? 27. Question Category: Pharmacological and Parenteral Therapies Patrick who is diagnosed with liver cirrhosis is experiencing symptoms of hepatic encephalopathy. The physician ordered 50 ml of Lactulose p.o. every 2 hours. Patrick suddenly develops diarrhea. The nurse best action would be: 28. Question Category: Physiological Adaptation Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm? 29. Question Category: Reduction of Risk Potential After undergoing a cardiac catheterization, Tracy has a large puddle of blood under his buttocks. Which of the following steps should the nurse take first? 30. Question Category: Physiological Adaptation Which of the following treatments is a suitable surgical intervention for a client with unstable angina? 31. Question Category: Physiological Adaptation The nurse is aware that the following terms used to describe reduced cardiac output and perfusion impairment due to ineffective pumping of the heart is: 32. Question Category: Physiological Adaptation A client with hypertension asks the nurse which factors can cause blood pressure to drop to normal levels? 33. Question Category: Pharmacological and Parenteral Therapies Nurse Rose is aware that the statement that best explains why furosemide (Lasix) is administered to treat hypertension is: 34. Question Category: Reduction of Risk Potential Nurse Nikki knows that laboratory results supports the diagnosis of systemic lupus erythematosus (SLE) is: 35. Question Category: Health Promotion and Maintenance Arnold, a 19-year-old client with a mild concussion is discharged from the emergency department. Before discharge, he complains of a headache. When offered acetaminophen, his mother tells the nurse the headache is severe and she would like her son to have something stronger. Which of the following responses by the nurse is appropriate? 36. Question Category: Reduction of Risk Potential When evaluating an arterial blood gas from a male client with a subdural hematoma, the nurse notes the Paco2 is 30 mm Hg. Which of the following responses best describes the result? 37. Question Category: Management of Care When prioritizing care, which of the following clients should the nurse Olivia assess first? 38. Question Category: Physiological Adaptation JP has been diagnosed with gout and wants to know why colchicine is used in the treatment of gout. Which of the following actions of colchicines explains why it’s effective for gout? 39. Question Category: Physiological Adaptation Norma asks for information about osteoarthritis. Which of the following statements about osteoarthritis is correct? 40. Question Category: Pharmacological and Parenteral Therapies Ruby is receiving thyroid replacement therapy, develops the flu, and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication will put the client at risk for developing which of the following life-threatening complications? 41. Question Category: Physiological Adaptation Nurse Sugar is assessing a client with Cushing’s syndrome. Which observation should the nurse report to the physician immediately? 42. Question Category: Physiological Adaptation Cyrill with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client’s urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse’s suspicion of diabetes insipidus? 43. Question Category: Health Promotion and Maintenance Jomari is diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which of the following statements indicates that the client understands her condition and how to control it? 44. Question Category: Physiological Adaptation A 66-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which of the following disorders? 45. Question Category: Health Promotion and Maintenance Nurse Lourdes is teaching a client recovering from Addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? 46. Question Category: Reduction of Risk Potential Which of the following laboratory test results would suggest to the nurse Len that a client has a corticotropin-secreting pituitary adenoma? 47. Question Category: Reduction of Risk Potential A male client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by doing which of the following? 48. Question Category: Pharmacological and Parenteral Therapies Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Mariner should expect the dose’s: 49. Question Category: Reduction of Risk Potential The physician orders laboratory tests to confirm hyperthyroidism in a female client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? 50. Question Category: Health Promotion and Maintenance Rico with diabetes mellitus must learn how to self-administer insulin. The physician has prescribed 10 U of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? 51. Question Category: Reduction of Risk Potential Nurse Sarah expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? 52. Question Category: Basic Care and Comfort For a client with Graves’ disease, which nursing intervention promotes comfort? 53. Question Category: Physiological Adaptation Patrick is treated in the emergency department for a Colles’ fracture sustained during a fall. What is a Colles’ fracture? 54. Question Category: Physiological Adaptation Cleo is diagnosed with osteoporosis. Which electrolytes are involved in the development of this disorder? 55. Question Category: Physiological Adaptation Johnny, a firefighter, was involved in extinguishing a house fire and is being treated for smoke inhalation. He developed severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. He most likely has developed which of the following conditions? 56. Question Category: Physiological Adaptation A 67-year-old client develops acute shortness of breath and progressive hypoxia requiring right femur. The hypoxia was probably caused by which of the following conditions? 57. Question Category: Physiological Adaptation A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this? 58. Question Category: Physiological Adaptation A 62-year-old male client was in a motor vehicle accident as an unrestrained driver. He’s now in the emergency department complaining of difficulty of breathing and chest pain. On auscultation of his lung field, no breath sounds are present in the upper lobe. This client may have which of the following conditions? 59. Question Category: Physiological Adaptation If a client requires a pneumonectomy, what fills the area of the thoracic cavity? 60. Question Category: Physiological Adaptation Hemoptysis may be present in the client with a pulmonary embolism because of which of the following reasons? 61. Question Category: Reduction of Risk Potential Alvin with a massive pulmonary embolism will have an arterial blood gas analysis performed to determine the extent of hypoxia. The acid-base disorder that may be present is? 62. Question Category: Reduction of Risk Potential After a motor vehicle accident, Armand, a 22-year-old client, is admitted with a pneumothorax. The surgeon inserts a chest tube and attaches it to a chest drainage system. Bubbling soon appears in the water seal chamber. Which of the following is the most likely cause of the bubbling? 63. Question Category: Pharmacological and Parenteral Therapies Nurse Michelle calculates the IV flow rate for a postoperative client. The client receives 3,000 ml of Ringer’s lactate solution IV to run over 24 hours. The IV infusion set has a drop factor of 10 drops per milliliter. The nurse should regulate the client’s IV to deliver how many drops per minute? 64. Question Category: Pharmacological and Parenteral Therapies Mickey, a 6-year-old child with a congenital heart disorder is admitted with congestive heart failure. Digoxin (lanoxin) 0.12 mg is ordered for the child. The bottle of Lanoxin contains .05 mg of Lanoxin in 1 ml of solution. What amount should the nurse administer to the child? 65. Question Category: Health Promotion and Maintenance Nurse Alexandra teaches a client about elastic stockings. Which of the following statements, if made by the client, indicates to the nurse that the teaching was successful? 66. Question Category: Physiological Adaptation The primary reason for rapid continuous rewarming of the area affected by frostbite is to: 67. Question Category: Reduction of Risk Potential 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: 68. Question Category: Health Promotion and Maintenance 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? 69. Question Category: Safety and Infection Control 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? 70. Question Category: Physiological Adaptation 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 an understanding of phantom limb pain? 71. Question Category: Reduction of Risk Potential 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: 72. Question Category: Health Promotion and Maintenance The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be taught to avoid eating: 73. Question Category: Health Promotion and Maintenance A client is discharged home with a prescription for Coumadin (sodium warfarin). The client should be instructed to: 74. Question Category: Reduction of Risk Potential The nurse is assisting the physician with the removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to: 75. Question Category: Pharmacological and Parenteral Therapies A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for: