2020/2021 NCLEX-PN V5 Practice Exam 1 Questions and Answers with Explanations

  1. The nurse is in the process of administering PO medications. Which of the following drugs should not be administered at the same time? A. Levofloxacin (Levaquin) and Mylanta B. Furosemide (Lasix) and Simethicone (Mylicon) C. Cyclobenzaprine (Flexeril) and Carbidopa (Sinemet) D. Sucralfate (Carafate) and docusate calcium (Surfak) Answer A: Administering Levofloxacin (Levaquin) and Mylanta at the same time will decrease the absorption of the fluoroquinolones. The drug combinations in answers B, C, and D are not contraindicated because the drugs in each combination do not affect one another. 2. The nurse caring for a client with hyperthyroidism would expect which group of clinical manifestations to be exhibited? A. Confusion, weakness, and increased weight B. Shortness of breath, dyspnea, and decreased libido C. Restlessness, fatigue, and weight loss D. Diuresis, hypokalemia, and tachycardia Answer C: A hyperactive thyroid causes hypermetabolism and increased sympathetic nervous system activity. Weight gain occurs with hypothyroidism, making answer A incorrect. Although tachycardia occurs with hyperthyroidism, diuresis and hypokalemia do not, so answer D is incorrect. Dyspnea can occur with this disorder, but clients exhibit increased libido, making answer B incorrect. 3. Which medication would the nurse expect to be prescribed for a client exhibiting tetany after thyroid surgery? A. Calcium B. Sodium C. Potassium D. Iodide Answer A: Tetany is caused by a decrease in calcium. Answers B, C, and D are not used in the treatment plan for clients with hypocalcemia. 4. The nurse should assess a client who has a peptic ulcer for signs of bleeding. Which symptom would best indicate this complication? A. Melena B. Hematuria C. Hemoptysis D. Ecchymosis Answer A: Melena is blood in the stools, which would occur with bleeding in the gastrointestinal tract due to a peptic ulcer. Answers B, C, and D are not specific to the GI system so are incorrect. Hematuria (blood in the urine) is not indicative of a peptic ulcer, blood from the lungs can occur as hemoptysis but is not related to this problem, and ecchymosis indicates bruising. 5. The nurse is preparing to administer insulin to a diabetic. Ten units regular and 35 units of NPH are ordered. Which of the following is the proper procedure for drawing up the medications? A. Draw up the insulin in two separate syringes, to prevent confusion. B. Draw up the NPH insulin before drawing up the regular. C. Inject air into the NPH vial, draw up 35 units, then inject air into the regular insulin vial and withdraw until insulin is at the 45 unit level. D. Inject 35 units of air into the NPH, inject 10 units of air into the regular, withdraw 10 units of regular, and then withdraw 35 units of NPH. Answer D: When mixing insulins, air should be injected into both vials before drawing up the dose, and clear (Regular) insulin should be drawn up before cloudy (NPH). Answer A would require two injections, which is not necessary. Answers B and C are incorrect procedures because regular insulin, not NPH, should be drawn up first. 6. What does the nurse recognize as the primary reason that food and fluids are withheld from clients with pancreatitis? A. Decrease blood flow to the pancreas B. Decrease stimulation of the pancreas C. Increase secretion of pancreatic enzymes D. Increase insulin production by the pancreas Answer B: Pancreatic enzyme secretion is activated by food and fluid. Therefore, keeping the client NPO will prevent the pancreas from secreting, resulting in decreased pain and damage to the pancreas. Answers A and D would produce negative outcomes and would have no relationship to why food and fluids are withheld. Because pancreatic enzymes are decreased by withholding food and fluids, answer C is incorrect. 7. The nurse is administering digoxin (Lanoxin) to a client with congestive heart failure. What is the expected therapeutic effect of this drug? A. Increased force of heart contraction B. Increased heart rate C. Decreased perfusion of the heart muscle D. Decreased cardiac output Answer A: Digoxin (Lanoxin) increases the force of the contraction of the heart, thus increasing the cardiac output. Answer D is incorrect because Lanoxin increases cardiac output. Lanoxin slows the heart rate, making answer B incorrect. Answer C could result in a myocardial infarction and is not the effect of the drug. 8. A client has just returned from a bronchoscopy. Which safety measure is most important for the nurse to implement? A. Maintaining the client in the supine position B. Providing the client with saline gargles every 15 minutes for 2 hours C. Monitoring the client for return of the gag reflex before PO intake D. Splinting the abdomen when coughing Answer C: A loss of gag reflex can occur due to the anesthetizing agent used for the tube insertion. It is most important to ensure an intact reflex before administering food or fluids because of the danger of aspiration. The position in answer A would be contraindicated because of possible increased secretions. Answer B would be instituted at a later time. Answer D would be necessary for clients with abdominal surgery. 9. A 45-year-old client returned from a colon resection 2 hours ago. Which vital signs indicate possible hemorrhagic shock? A. BP 120/80, heart rate 88 B. BP 170/100, heart rate 120 C. BP 160/98, heart rate 54 D. BP 96/60, heart rate 120 Answer D: Vital sign changes with hemorrhagic shock are decreasing blood pressure with an increased heart rate. Answer A is a normal BP and heart rate. Answers B and C are abnormal vital signs but do not correlate with hemorrhagic shock. 10. A client with newly diagnosed acquired immunodeficiency syndrome (AIDS) asks the nurse if it’s necessary to tell co-workers about the diagnosis. The nurse’s response is based on which correct understanding? A. Transmission of AIDS doesn’t occur through casual contact B. Employees have a right to choose with whom they will work C. Clients with an AIDS diagnosis should not work in public places D. The law requires that employers be informed of an AIDS diagnosis Answer A: AIDS is transmitted by transfer of blood and bodily fluids, not by casual contact. Answers B, C, and D are incorrect statements about AIDS. Some states require sexual contact notification; otherwise, confidentially is maintained. 11. A client is returning to the room after a thyroidectomy. Which piece of equipment should the nurse place at the bedside? A. A tracheotomy set B. A hemostat C. A chest tube system D. Wire cutters Answer A: A tracheotomy set is placed at the bedside as a safety measure in case the client has severe edema or respiratory distress. The pieces of equipment in answers B, C, and D are not required or helpful after a thyroidectomy. 12. A client with a hip fracture is receiving heparin sub-cutaneously. Which laboratory test should the nurse monitor when administering this medication? A. Prothrombin time B. Vitamin K level C. Activated partial thromboplastin time D. Fibrin split levels Answer C: aPTTs should be monitored on clients receiving heparin. The goal is 1.5 to 2 times the control for prevention of deep vein thrombosis. Answer A is used for the monitoring of Coumadin therapy. Answer B is the antidote for too much Coumadin. Answer D is not a test used for heparin or Coumadin. 13. What teaching should the nurse reinforce to a young male adult regarding when he should perform testicular self-examinations? A. Weekly after becoming sexually active B. Monthly while in the shower C. Bimonthly after age 40 D. Annually on his birthday Answer B: This is the American Cancer Society’s recommendation for testicular examination. Answers A, C, and D are not the correct timing sequences for a testicular examination. 14. The nurse is reinforcing teaching to a client with a hiatal hernia. Which would be included in the teaching plan? A. Eat a puréed diet B. Avoid the intake of sweets C. Remain in an upright position after meals D. Limit protein to 3 oz. once a day Answer C: Remaining upright will decrease the chance of esophageal reflux. Clients should avoid fatty foods, coffee, tea, cola, chocolate, alcohol, and spicy and acidic foods, which makes answers B and D incorrect. Puréed diets, as in answer A, are not recommended. 15. A client who is in end-stage cirrhosis should restrict which of these foods? A. Apples B. Broccoli C. Beef D. Rolls Answer C: With clients who are in end-stage cirrhosis, proteins are restricted because of the inability of the liver to convert the protein for excretion. This results in build-up of ammonia in the body. Answers A, B, and D are not restricted foods. 16. The nurse is providing initial first aid for a client with thermal burn injury in a community setting. Which action is appropriate? A. Apply betadine ointment over the area affected B. Cover the burn with an occlusive dressing C. Flush the burned area with cool water D. Remove any adhered clothing that is on the burn area Answer C: Cooling the burn stops the burn process, relieving pain and limiting edema. This is the initial action. Answers A and B are not initial actions to be performed in the field. Adherent clothing should remain in place after being cooled, so answer D is incorrect. 17. A client with suspected myasthenias gravis has been administered the drug edrophonium chloride (Tensilon). Which effect would the nurse expect the client to exhibit after administration? A. Decreased motor strength B. Decreased seizure activity C. Increased muscle strength D. Increased cognitive functioning Answer C: Clients with myasthenia gravis have a decrease in muscular strength because of a lack of acetylcholine. Tensilon administration halts the breakdown of acetylcholine, causing an increase in muscular strength that confirms the diagnosis. Answer A would indicate that the client does not have myasthenias gravis. Answers B and D are not an effect of the drug Tensilon. 18. A client is admitted with hypothyroidism. Which clinical manifestation would the nurse expect the client to exhibit? A. Diarrhea B. Intolerance to cold C. Hyperactivity D. Diaphoresis Answer B: These clients have a subnormal temperature and pulse rate, causing them to have a decreased tolerance of cold. Answers A, C, and D are symptoms of hyperthyroidism, so they are incorrect. 19. The nurse caring for a client with Alzheimer’s disease should initiate which of the following when requesting an action by the client? A. Provide a detailed explanation B. Give one direction at a time C. Offer two choices for each activity D. Provide all instructions at one time