NCLEX RN JULY 2022 FILES

NCLEX RN JULY 2022 TESTED THIS JULY QUESTIONS AND ANSWERS CHRISJAY FILES The nurse is completing an assessment of a child in the clinic. Which of the following should be documented in the child's health history? Select all that apply. 1.‐ The child was born by cesarean section. 2.‐ Mother states child has a rash 3.‐ Child appears feverish 4.‐ Diminished reflexes 5.‐ Older sister had the chicken pox recently. A 10-month-old infant's mother says that he takes fresh whole milk eagerly, but that when she offered him baby foods at 6 months of age, he pushed them out of his mouth. Because he has gained weight appropriately, she has quit trying to get him to eat other foods. The nurse's response is based on the knowledge that: A. Milk intake should be limited to no more than four 8-oz bottles per day and should be followed by iron-enriched cereal or other solid foods or juices B. Milk is an excellent food and will meet his nutritional needs adequately until he is ready to eat solid foods C. It is acceptable to continue to give him whole milk and to delay giving solid foods as long as he takes a vitamin supplement daily D. He should be started on iron-enriched cereal, meat, vegetables, fruits, and juices prior to bottle feeds. Milk intake should be limited to 1 qt/day A 9-month-old infant was diagnosed with nonorganic failure to thrive. During her hospitalization, primary nurses were assigned to initiate all infant feedings. The infant's parents question why they cannot feed their own child. Which of the following responses would be most appropriate by the nurse? A. By assigning the same nurses to the child, the nurses can begin to learn the infant's cues and feeding behaviors. B. The same nurses will prevent parental fatigue and frustration. C. The same nurses will prevent infant fatigue and frustration. D. Primary nurses will ensure privacy. The parents of a 2-year-old child are ready to begin toilet training activities with him. His parents feel he is ready to train because he is now 2 years old. What would the nurse identify as readiness in this child? A. Patience by the child when wearing soiled diapers B. Communicating the urge to defecate or urinate C. The child awakening wet from his naps D. The age at which the child's siblings were trained A 5-year-old child is hospitalized for an acute illness. The nurse encourages the family to bring her favorite objects from home. What is the nurse's rationale? A. To reduce fear of the unknown B. To keep the child calm C. To establish a trusting relationship CHRISJAY FILES D. To prevent or minimize separation anxiety A 3-year-old child was hospitalized for acute laryngotracheobronchitis. During her hospitalization, the child was placed under an oxygen mist tent. The nurse's frequent monitoring of the child's temperature frightened her parents. Which response by the nurse would be most appropriate? A. Monitoring the temperature prevents undue chilling. B. Rapid temperature elevations can occur in children. C. Checking the temperature will prevent febrile seizures. D. Taking the child's temperature can prevent airway obstruction. The nurse is teaching a group of adults about health screenings for cancer. The nurse would include in the discussion which of the following points? Select all that apply. 1.‐ Genetic screening is helpful in identification of cancer risks. 2.‐ Annual medical exams uncover most tumors. 3.‐ Men need to perform breast and testicle exams monthly. 4.‐ Annual mammograms are recommended after a total mastectomy. 5.‐ Inspection of the skin for cancer becomes less important as one ages. A school-age child with asthma is ready for discharge from the hospital. His physician has written an order to continue the theophylline given in the hospital as an oral home medication. Immediately prior to discharge, he complains of nausea and becomes irritable. His vital signs were normal except for tachycardia. What first nursing actions would be essential in this situation? A. Hold the child's discharge for 1 hour. B. Notify the physician immediately. C. Discharge the child as the physician ordered. D. Administer an antiemetic as necessary. A neonate was admitted to the hospital with projectile vomiting. According to the parents, the baby had experienced vomiting episodes after feeding for the last 2 days. A medical diagnosis of hypertrophic pyloric stenosis was made. On assessment, the infant had poor skin turgor, sunken eyeballs, dry skin, and weight loss. Identify the number-one priority nursing diagnosis. A. Fluid volume deficit B. Altered nutrition C. Altered bowel elimination D. Anxiety A baby who was diagnosed with pyloric stenosis has continued to have projectile vomiting. With prolonged vomiting, the infant is prone to: A. Respiratory acidosis CHRISJAY FILES B. Respiratory alkalosis C. Metabolic acidosis CHRISJAY FILES D. Metabolic alkalosis Parents of young children often need anticipatory guidance from the nurse. Parents may have little knowledge regarding growth and development. Which of the following toys and activities would the nurse suggest as appropriate for a toddler? A. Cutting, pasting, string beads, music, dolls B. Mobiles, rattle, squeeze toys C. Pull-toys, large ball, dolls, sand and water play, music D. Simple card games, puzzles, bicycle, television A 5-year-old child cries continually in her bed. Her parents have been unsuccessful in assisting her in expressing her feelings. Which activity should the nurse provide the child to assist her in expressing her feelings? A. Books with colorful pictures B. Music C. Riding toys CHRISJAY FILES D. Puppets During his hospitalization, a 3-year-old child has become unusually aggressive in his play activities. His parents report this change in behavior to the primary nurse. How could the nurse explain the child's change in behavior? A. Deep-seated feelings of hostility B. A lack of interest in socializing C. Usual behavior for this child D. A coping response Following her surgery, a 5-year-old child will return to the pediatric unit with a long-arm cast. She experienced a supracondylar fracture of the humerus near the elbow. Which nursing action is most essential during the first 24 hours after surgery and cast application? A. Mobilization of the child B. Discharge teaching C. Pain management D. Assessment of neurovascular status A 9-month-old infant visits her pediatrician for a routine visit. A developmental assessment was initiated by the nurse. Which skill would cause the nurse to be concerned about the infant's developmental progression? A. She sits briefly alone with assistance. B. She creeps and crawls. C. She pulls herself to her feet with help. D. She stands while holding onto furniture. Children often experience visual impairments. Refractive errors affect the child's visual activity. The main refractive error seen in children is myopia. The nurse explains to the child's parents that myopia may also be described as: A. Cataracts B. Farsightedness C. Nearsightedness D. Lazy eye CHRISJAY FILES A client is experiencing visual problems at school. She has complained of difficulty seeing the blackboard and squinting. She no longer likes to participate in physical activities such as softball. The client has displayed possible classic symptoms of which refractive error? A. Astigmatism B. Hyperopia C. Myopia D. Amblyopia An 18-year-old client enters the emergency room complaining of coughing, chest tightness, dyspnea, and sputum production. On physical assessment, the nurse notes agitation, nasal flaring, tachypnea, and expiratory wheezing. These signs should alert the nurse to: A. A tension pneumothorax B. An asthma attack C. Pneumonia D. Pulmonary embolus The nurse is assisting a 4th-day postoperative cholecystectomy client in planning her meals for tomorrow's menu. Which vitamin is the most essential in promoting tissue healing? A. Vitamin C B. Vitamin B1 C. Vitamin D D. Vitamin A As a postoperative cholecystectomy client completes tomorrow's dinner menu, the nurse knows that one of the following meal choices will best provide the essential vitamin(s) necessary for proper tissue healing? A. Liver, white rice, spinach, tossed salad, custard pudding B. Fish fillet, carrots, mashed potatoes, butterscotch pudding C. Roast chicken, gelatin with sliced fruit D. Chicken breast fillet in tomato sauce, potatoes, mustard greens, orange and strawberry slices The pediatric nurse would perform abdominal percussion to assess which of the following? (Select all that apply.) 1.‐ Generalized tenderness 2.‐ Local inflammation 3.‐ Density of tissues and organs 4.‐ Size and placement of liver 5.‐ Borders and size of abdominal organs CHRISJAY FILES A 71-year-old client fell and injured her left leg while cooking in the kitchen. Her husband calls the ambulance, and she is taken to the emergency department at a local hospital. X-ray reports confirm that she has an intertrochanteric fracture of the left femur. Her left leg will require skeletal traction initially and then surgery. The nurse knows that this type of traction will be used: A. By inserting pins to provide steady pull on the bone B. To suspend the leg in a sling without pull on the extremity C. Intermittently to place a pull over the pelvis and lower spine D. With weights at both ends of the bed to maintain pull on the upper extremity Pin care is a part of the care plan for a client who is in skeletal traction. When assessing the site of pin insertion, which one of the following findings would the nurse know as an indicator of normal wound healing? A. Exudate B. Crust C. Edema D. Erythema A 47-year-old client comes to the emergency department complaining of moderate flank, abdominal, and testicular pain with nausea of 4 hours' duration. After physical examination and obtaining the client's history, the physician suspects urethral obstruction by calculi. The nurse realizes that the physician will order which one of the following diagnostic studies to best confirm the diagnosis? A. Cystoscopy B. Kidneys, ureter, bladder, x-ray of abdomen C. Intravenous pyelogram with excretory urogram D. Ureterolithotomy An obstructing stone in the renal pelvis or upper ureter causes: A. Radiating pain into the urethra with labia pain experienced in females or testicular pain in males B. Urinary frequency and dysuria C. Severe flank and abdominal pain with nausea, vomiting, diaphoresis, and pallor D. Dull, aching, back pain A client who has gout is most likely to form which type of renal calculi? A. Struvite stones B. Staghorn calculi C. Uric acid stones D. Calcium stones CHRISJAY FILES A 75-year-old client is hospitalized with pneumonia caused by gram-positive bacteria. Which one of the following best describes a gram-positive bacterial pneumonia? A. Klebsiellapneumonia B. Pneumococcal pneumonia C. Legionella pneumophilapneumonia D. Escherichia colipneumonia The nurse caring for a client who has pneumonia, which is caused by a gram-positive bacteria, inspects her sputum. Because the client's pneumonia is caused by a gram-positive bacteria, the nurse experts to find the sputum to be: A. Bright red with streaks B. Rust colored C. Green colored D. Pink-tinged and frothy The nurse who is caring for a client with pneumonia assesses that the client has become increasingly irritable and restless. The nurse realizes that this is a result of: A. Prolonged bed rest B. The client's maintaining a semi-Fowler position C. Cerebral hypoxia D. IV fluids of 2.53 liters in 24 hours A 22-year-old client who is being seen in the clinic for a possible asthma attack stops wheezing suddenly as the nurse is doing a lung assessment. Which one of the following nursing interventions is most important? A. Place the client in a supine position. B. Draw a blood sample for arterial blood gases. C. Start O2 at 4 L/min. D. Establish a patent airway. A 49-year-old obese woman has been admitted to the general surgery unit with choledocholithiasis. As the nurse is admitting her to the unit, she states, "The doctor said I have stones that need to be removed; where are they?" The nurse knows that the best explanation for this is to tell her that: A. There are stones present in her gallbladder B. There are stones present in her kidneys C. There are stones present in her common bile duct D. There are no stones, but her gallbladder is irritated and caused her nausea, vomiting, and pain CHRISJAY FILES A 48-year-old client is being seen in her physician's office for complaints of indigestion, heartburn, right upper quadrant pain, and nausea of 4 days' duration, especially after meals. The nurse realizes that these symptoms may be associated with cholecystitis and therefore would check for which specific sign during the abdominal assessment? A. Cullen's sign B. Rebound tenderness C. Murphy's sign D. Turner's sign When caring for a postoperative cholecystectomy client, the nurse assesses patency and documents drainage of the T-tube. The nurse recognizes that the expected amount of drainage during the first 24 hours postoperatively is: A. 50100 mL B. mL C. mL D. mL The nurse recognizes that a client with the diagnosis of cholecystitis and cholelithiasis would expect to have stools that are: A. Clay or gray colored B. Watery and loose C. Bright-red streaked D. Black CHRISJAY FILES A 52-year-old client who underwent an exploratory laparotomy for a bowel obstruction begins to complain of hunger on the third postoperative day. His nasogastric (NG) tube was removed this morning, and he has an IV of D5W with 0.45% normal saline running at 125 mL/hr. He asks when he can get rid of his IV and start eating. The nurse recognizes that he will be able to begin taking oral fluids and nourishment when: A. It is determined that he has no signs of wound infection B. He is able to eat a full meal without evidence of nausea or vomiting C. The nurse can detect bowel sounds in all four quadrants D. His blood pressure returns to its preoperative baseline level or greater A 47-year-old client has been admitted to the general surgery unit for bowel obstruction. The doctor has ordered that an NG tube be inserted to aid in bowel decompression. When preparing to insert a NG tube, the nurse measures from the: A. Lower lip to the shoulder to the upper sternum B. Tip of the nose to the lower lip to the umbilicus C. End of the tube to the first measurement line on the tube D. Tip of the nose to the ear lobe to the xiphoid process or midepigastric area A 65-year-old client who has a new colostomy is preparing for discharge from the hospital. As part of the instructions on colostomy care, the nurse explains to the client that to regulate the bowel, colostomy irrigation should be performed at the same time each day. The best time is: A. After meals B. Before meals C. Every 2 hours D. At bedtime A 72-year-old client with a new colostomy is being evaluated at the clinic today for constipation. When discussing diet with the client, the nurse recognizes that which one of the following foods most likely caused this problem? A. Fried chicken B. Eggs C. Tapioca D. Cabbage When giving discharge instructions to a 24-year-old client who had a short-arm cast applied for a fractured right ulna, the nurse recognizes the importance of telling him that the drying time for a plaster of Paris cast is approximately: A. 30 minutes B. 14 hours C. 1224 hours CHRISJAY FILES D. 2472 hours CHRISJAY FILES A 58-year-old client on a general surgery unit is scheduled for transurethral resection of the prostate (TURP) in 2 hours. The nurse explains to the client that this procedure means: A. Removal of the prostate tissue by way of a lower abdominal midline incision through the bladder and into the prostate gland B. Removal of prostate tissue by a resectoscope that is inserted through the penile urethra C. Removal of the prostate tissue by an open surgical approach through an incision between the ischial tuberosities, the scrotum, and the rectum D. Removal of prostate tissue by an open surgical approach through a low horizontal incision, bypassing the bladder, to the prostate gland A postoperative TURP client returns from the recovery room to the general surgery unit and is in stable condition. One hour later the nurse assesses him and finds him to be confused and disoriented. She recognizes that this is most likely caused by: A. Hypovolemic shock B. Hypokalemia C. Hypernatremia D. Hyponatremia A postoperative TURP client is ordered continuous bladder irrigations. Later in the evening on the first postoperative day, he complains of increasing suprapubic pain. When assessing the client, the nurse notes diminished flow of bloody urine and several large blood clots in the drainage tubing. Which one of the following should be the initial nursing intervention? A. Call the physician about the problem. B. Irrigate the Foley catheter. C. Change the Foley catheter. D. Administer a prescribed narcotic analgesic. A postoperative prostatectomy client is preparing for discharge from the hospital the next morning. The nurse realizes that additional instructions are necessary when he states: A. "If I drink 10 to 12 glasses of fluids each day, that will help to prevent any clot formation in my urine." B. "The isometric exercises will help to strengthen my perineal muscles and help me control my urine." C. "If I feel as though I have developed a fever, I will take a rectal temperature, which is the most accurate." D. "I do not plan to do any heavy lifting until I visit my doctor again." A 67-year-old postoperative TURP client has hematuria. The nurse caring for him reviews his postoperative orders and recognizes that which one of the following prescribed medications would best relieve this problem? A. Acetaminophen suppository 650 mg B. Meperidine 50 mg IM C. Promethazine 25 mg IM D. Aminocaproic acid (Amicar) 6 g/24 hr CHRISJAY FILES A 52-year-old client is scheduled for a small-bowel resection in the morning. In conjunction with other preoperative preparation, the nurse is teaching her diaphragmatic breathing exercises. She will teach the client to: A. Inhale slowly and deeply through the nose until the lungs are fully expanded, hold the breath a couple of seconds, and then exhale slowly through the mouth. Repeat 23 more times to complete the series every 12 hours while awake B. Purse the lips and take quick, short breaths approximately 1820 times/min C. Take a large gulp of air into the mouth, hold it for 1015 seconds, and then expel it through the nose. Repeat 45 times to complete the series D. Inhale as deeply as possible and then immediately exhale as deeply as possible at a rate of approximately 2024 times/min A 27-year-old healthy primigravida is brought to the labor and birthing room by her husband at 32 weeks' gestation. She experienced a sudden onset of painless vaginal bleeding. Following an ultrasound examination, the diagnosis of bleeding secondary to complete placenta previa is made. Expected assessment findings concerning the abdomen would include: A. A rigid, boardlike abdomen B. Uterine atony C. A soft relaxed abdomen D. Hypertonicity of the uterus A 27-year-old primigravida stated that she got up from the chair to fix dinner and bright red blood was running down her legs. She denies any pain previously or currently. The client is very concerned about whether her baby will be all right. Her vital signs include P 120 bpm, respirations 26 breaths/min, BP 104/58 mm Hg, temperature 98.2_F, and fetal heart rate 146 bpm. Laboratory findings revealed hemoglobin 9.0 g/dL, hematocrit 26%, and coagulation studies within normal range. On admission, the peripad she wore was noted to be half saturated with bright red blood. A medical diagnosis of placenta previa is made. The priority nursing diagnosis for this client would be: A. Decreased cardiac output related to excessive bleeding B. Potential for fluid volume excess related to fluid resuscitation C. Anxiety related to threat to self D. Alteration in parenting related to potential fetal injury A 27-year-old primigravida at 32 weeks' gestation has been diagnosed with complete placenta previa. Conservative management including bed rest is the proper medical management. The goal for fetal survival is based on fetal lung maturity. The test used to determine fetal lung maturity is: A. Dinitrophenylhydrazine B. Metachromatic stain C. Blood serum phenylalanine test D. Lecithin-sphingomyelin ratio The physician of a client diagnosed with alcoholism orders neomycin 0.5 g q6h to prevent hepatic coma. Neomycin decreases serum ammonia levels by: CHRISJAY FILES A. Decreasing nitrogen-forming bacteria in the intestines B. Acidifying colon contents by causing ammonia retention in the colon C. Decreasing the uptake of vitamin D, thereby drawing more water into the colon D. Irritating the bowel and promoting evacuation of stool A 26-year-old male client is brought by his wife to the emergency department (ED) unconscious. Blood is drawn for a stat blood count (CBC), fasting blood sugar level, and electrolytes. An indwelling urinary catheter is inserted. He has a history of type 1 diabetes (insulindependent diabetes mellitus [IDDM]). A diagnosis of ketoacidosis is made. Stat lab values reveal a blood sugar level of 520 mg/dL. Which of the following should the nurse expect to administer in the ER? A. D50W by IV push B. NPH insulin SC C. Regular insulin by IV infusion D. Sweetened grape juice by mouth A client with IDDM is given IV insulin for a blood glucose level of 520 mg/dL. Life-threatening complications may occur initially, so the nurse will monitor him closely for serum: A. Chloride level of 99 mEq/L B. Sodium level of 136 mEq/L C. Potassium level of 3.1 mEq/L D. Potassium level of 6.3 mEq/L An IDDM client's condition stabilizes. He begins to receive a daily injection of NPH insulin at 6:30 AM. The nurse can most likely expect a hypoglycemic reaction to occur that same day at: A. 8:30 AM10:30 AM B. 2:30 PM4:30 PM C. 7:30 PM9:30 PM D. 10:30 PM11:30 PM After several days, an IDDM client's serum glucose stabilizes, and the registered nurse continues client teaching in preparation for his discharge. The nurse helps him plan an American Diabetes Association diet and explains how foods can be substituted on the exchange list. He can substitute 1 oz of poultry for: A. One frankfurter B. One ounce of ham C. Two slices of bacon D. One-fourth cup dry cottage cheese CHRISJAY FILES W