NCLEX Practice Exam Question
and Answers
After receiving report at the start of the evening shift, which of
the following clients should the nurse attend to first?
(a) A 34-year-old man undergoing treatment for non-Hodgkin
lymphoma with a potassium level of 7.5 mEq/L.
(b) A 21-year-old woman with sickle cell anemia with pain of 6 on
a scale of 1-10.
(c) A 55-year-old woman with ovarian cancer waiting to be
discharged.
(d) A 72-year-old man with chronic obstructive pulmonary
disease (COPD) and a pulse oximetry of 96% on room air. - -
Correct answer: (a) A 34-year-old man undergoing treatment for
non-Hodgkin lymphoma with a potassium level of 7.5 mEq/L.
Rationale: Hyperkalemia is a potentially serious condition that, in
a client undergoing treatment for non-Hodgkin lymphoma, could
indicate tumour lysis syndrome. Patient (b) should be attended
to, but her condition is not as urgent. Patients (c) and (d) do not
require immediate attention.
-A 34-year-old woman who developed Stevens-Johnson syndrome
while undergoing treatment with carbamazepine (Tegretol) is
being transferred in stable condition from the intensive care unit
to the medical unit. There are 4 beds available. The nurse knows
the best choice of roommates for this client is which of the
following?
(a) A 40-year-old man with methicillin-resistant Staphylococcus
aureus (MRSA).
(b) A 28-year-old woman diagnosed with diarrhea.
(c) A 72-year-old man with fever of unknown origin.
(d) A 68-year-old woman with atrial fibrillation . - -Correct
answer: (d) A 68-year-old woman with atrial fibrillation.
, Rationale: A client with Stevens-Johnson syndrome is likely to
have severe skin integrity issues, including blistering and skin
shedding, which can place the client at high risk for infection.
Atrial fibrillation is not an infectious process. All other patients
may be an infection risk for an individual with altered skin
integrity.
-A 72-year-old man who had a stroke is being transferred from a
medical unit to a rehabilitation centre. The nurse case manager
is assisting in the process. The nurse knows that the goals of
case management include which of the following? Select all that
apply.
(a) Improving the coordination of care
(b) Increasing referrals to local organizations
(c) Reducing the fragmentation of care
(d) Discharging clients quickly - -Correct answer: (a) Improving
the coordination of care; and (c) Reducing the fragmentation of
care
Rationale: Some of the primary goals of case management are to
improve the coordination of care and to reduce fragmentation of
care. The other options are not goals of case management.
-A pregnant woman at 15 weeks' gestation is scheduled for an
amniocentesis. As the client is being prepped for the procedure,
it becomes clear to the nurse that the client doesn't fully
understand the risks and benefits associated with the procedure.
Which of the following describe the nurse's role in obtaining
informed consent? Select all that apply.
(a) Explain the risks and benefits associated with the procedure.
(b) Describe alternatives to the procedure.
(c) Witness the client's signature on the consent form.
(d) Advocate for the client by ensuring she is making an informed
decision. - -Correct answer: (c) Witness the client's signature on
the consent form; and
(d) Advocate for the client by ensuring she is making an informed
decision.
and Answers
After receiving report at the start of the evening shift, which of
the following clients should the nurse attend to first?
(a) A 34-year-old man undergoing treatment for non-Hodgkin
lymphoma with a potassium level of 7.5 mEq/L.
(b) A 21-year-old woman with sickle cell anemia with pain of 6 on
a scale of 1-10.
(c) A 55-year-old woman with ovarian cancer waiting to be
discharged.
(d) A 72-year-old man with chronic obstructive pulmonary
disease (COPD) and a pulse oximetry of 96% on room air. - -
Correct answer: (a) A 34-year-old man undergoing treatment for
non-Hodgkin lymphoma with a potassium level of 7.5 mEq/L.
Rationale: Hyperkalemia is a potentially serious condition that, in
a client undergoing treatment for non-Hodgkin lymphoma, could
indicate tumour lysis syndrome. Patient (b) should be attended
to, but her condition is not as urgent. Patients (c) and (d) do not
require immediate attention.
-A 34-year-old woman who developed Stevens-Johnson syndrome
while undergoing treatment with carbamazepine (Tegretol) is
being transferred in stable condition from the intensive care unit
to the medical unit. There are 4 beds available. The nurse knows
the best choice of roommates for this client is which of the
following?
(a) A 40-year-old man with methicillin-resistant Staphylococcus
aureus (MRSA).
(b) A 28-year-old woman diagnosed with diarrhea.
(c) A 72-year-old man with fever of unknown origin.
(d) A 68-year-old woman with atrial fibrillation . - -Correct
answer: (d) A 68-year-old woman with atrial fibrillation.
, Rationale: A client with Stevens-Johnson syndrome is likely to
have severe skin integrity issues, including blistering and skin
shedding, which can place the client at high risk for infection.
Atrial fibrillation is not an infectious process. All other patients
may be an infection risk for an individual with altered skin
integrity.
-A 72-year-old man who had a stroke is being transferred from a
medical unit to a rehabilitation centre. The nurse case manager
is assisting in the process. The nurse knows that the goals of
case management include which of the following? Select all that
apply.
(a) Improving the coordination of care
(b) Increasing referrals to local organizations
(c) Reducing the fragmentation of care
(d) Discharging clients quickly - -Correct answer: (a) Improving
the coordination of care; and (c) Reducing the fragmentation of
care
Rationale: Some of the primary goals of case management are to
improve the coordination of care and to reduce fragmentation of
care. The other options are not goals of case management.
-A pregnant woman at 15 weeks' gestation is scheduled for an
amniocentesis. As the client is being prepped for the procedure,
it becomes clear to the nurse that the client doesn't fully
understand the risks and benefits associated with the procedure.
Which of the following describe the nurse's role in obtaining
informed consent? Select all that apply.
(a) Explain the risks and benefits associated with the procedure.
(b) Describe alternatives to the procedure.
(c) Witness the client's signature on the consent form.
(d) Advocate for the client by ensuring she is making an informed
decision. - -Correct answer: (c) Witness the client's signature on
the consent form; and
(d) Advocate for the client by ensuring she is making an informed
decision.
