NCLEX RN UWORLD COMPREHENSIVE PRACTICE EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS | ALREADY GRADED A+RECENT VERSION

NCLEX RN UWORLD COMPREHENSIVE PRACTICE EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS | ALREADY GRADED A+RECENT VERSION 1) A client undergoing endotracheal intubation received iv sedation and succinylcholine. Shortly after respiratory status has been stabilized, the client flushed and profusely diaphoretic and has a rigid jaw. Which medication should the nurse prepare to administer? Click the exhibit button for more information. Exhibit: vital signs Temperature 105 f Blood pressure 140/90 mm hg Heart rate 150/min Respirations 28/min O2 saturation 98% - im epinephrine - iv atropine - iv dantrolene - iv glucagon - answer iv dantrolene - malignant hyperthermia is a rare and life-threatening condition precipitated by certain medications used for anesthesia, including inhaled anesthetics and succinylcholine. - skeletal muscles become unable to control calcium levels, leading to a hypermetabolic state manifested by contracture and increased temperature. - early sings of mh include tachypnea, tachycardia, and a rigid jaw or generalized rigidity. - as the condition progresses, the client develops a high fever - muscle tissue is broken down, leading to hyperkalemia, cardiac dysrhythmias, and myoglobinuria. 2) Mh requires emergent treatment with iv dantrolene to reverse the process by slowing metabolism. - succinylcholine should be discontinued. - other interventions include applying cooling blankets to reduce temperature and treating high potassium levels. 3) inhaled anethetics - answer - desflurane - isoflurane - halothane 4) succinylcholine - answer a paralytic used adjunctively for intubation and general anesthesia. 5) im epinephrine - answer administered for cardiac arrest, anaphylactic reactions, or severe asthma attacks 6) iv atropine - answer an anticholinergic agent, used to treat bradycardia. 7) iv glucagon - answer given im, subq, or iv for severe hypoglycemia. - iv glucose is preferred due to its immediate effect, however, if it is unavailable, glucagon can be given to stimulate glycogenolysis in the liver 8) the nurse is managing the care of a client diagnosed with chronic anxiety. Which behavior demonstrates to the nurse that the client possesses resilience? 1. Avoids anxiety-producing situations. 2. Is able to identify anxiety-inducing triggers 3. Practices stress reduction techniques daily 4. Relies on anxiolytic medication to manage symptoms - answer practices stress reduction techniques daily. - resilient people readily deal with the stress they face by using interventions such as deep breathing, meditation, thought interruption, and muscle relaxation. 9) the nurse reviews the laboratory results for 4 assigned clients. Which result is most important for the nurse to report to the primary health care provider? - client with atrial fibrillation receiving warfarin for 7 days with an international normalized ratio (inr) of 1.3 - client with chronic bronchitis who has a hematocrit of 56& and hemoglobin of 19 g/dl - client with clostridium difficile infections who has a white blood cell count of 15.000/mm3 - client with sepsis receiving gentamycin who has a creatinine of 0.6 mg/dl - answer client with atrial fibrillation receiving warfarin for 7 days with an international normalized ratio (inr) of 1.3 - the therapeutic inr level for a client receiving warfarin to treat atrial fibrillation is 2-3. - the subtherapeutic inr of 1.3 is the most important result to report to the health care provider as the client is at increased risk for a stroke and dose adjustment is needed 10) a client at 35 weeks gestation is admitted to the labor and delivery unit for severe pre-eclampsia. She is started on iv magnesium sulfate for seizure prophylaxis. Which of the following signs indicated that the client had developed magnesium sulfate toxicity? Select all that apply. - 0/4 patellar reflex - blood pressure of 156/84 mm hg - client voiding 600 ml in 8 hours - respirations of 10/min - serum magnesium level of 8.0 meq/l - answer - 0/4 patellar reflex - respirations 10/min - serum magnesium level of 8.0 meq/l - therapeutic magnesium levels: 4-7 meq/l - mag toxicity: 7 11) iv magnesium sulfate (seizure eclampsia prophylaxis) - answer - loading dose of 4-6 g - followed by maintenance dose of 1-2 g/hr - therapeutic level: 4-7 meq/l 12) magnesium toxicity clinical features - answer - mild: nausea, flushing, headache, hyporeflexia - moderate: areflexia, hypocalcemia, somnolence - severe: respiratory paralysis, cardiac arrest - absent or decreased deep tendon reflexes are the earliest sign 13) magnesium toxicity: treatment - answer - stop magnesium therapy - give iv calcium gluconate 14) a recently widowed client becomes tearful at a routine clinic visit and states, "i just can't get over my spouse's death." which of the following responses by the nurse are appropriate? Select all that apply. - "a friend of mine passed away recently. I know how hard losses can be." - "i see that you're upset. I will step out while you process these feelings." - "it may take a while, but coming to terms with loss gets easier with time." - "this is a difficult time. Tell me about how you have been coping." - "what are your thoughts about attending a grief support group?" - answer -"this is a difficult time. Tell me about how you've been coping." - "what are your thoughts about attending a grief support group?" - reflection (acknowledging client statements) and using open-ended questions or statements assist the client in exploring emotions and allow for expression of needs. Nurses may also suggest strategies and share resources to facilitate the client's grieving process. 15) a client diagnosed with trigeminal neuralgia is given a prescription of carbamazepine by the health care provider. Which intervention does the nurse add to this client's care plan? - encourage the client to drink cold beverages - encourage the client to eat a high-fiber diet - encourage the client to perform facial massage - encourage the client to report any fever or sore throat. - answer encourage the client to report any fever or sore throat. - carbamazepine is a seizure medication but is highly effective for neuropathic pain. - carbamazepine is associated with agranulocytosis (leukopenia) and infection risk 16) trigeminal neuralgia - answer a sudden, sharp pain along the distribution of the trigeminal nerve. - symptoms are usually unilateral and primarily in the maxillary and mandibular branches. - clients may experience chronic pain with periods of less severe pain, or "cluster attacks" of pain between long periods without pain. - triggers can include washing the face, chewing food, brushing teeth, yawning, or talking - pain is severe, intense, burning, or electric shock-like - the primary intervention is consistent pain control with medications and lifestyle changes. 17) behavioral interventions for trigeminal neuralgia - answer - oral care: use a small, soft-bristled toothbrush or a warm mouth wash - use lukewarm water; avoid beverages or food that are too hot or cold - room should be kept at an even and moderate temperature - avoid rubbing or facial massage. Use cotton pads to wash face if necessary. - have a soft diet with high calorie content, avoid foods that are difficult to chew. Chew on the unaffected side of the mouth. 18) which of the following drug administrations should be reported as a practice error? Select all that apply. - cephalexin administered; client has history of anaphylaxis from penicillin - hydromorphone 2 mg administered; client reports pruritus - immunization for 3-month-old administered in ventrogluteal site - oral niacin (nicotinic acid) administered; client has facial flushing - warfarin administered; client at 12 weeks gestation - answer - cephalexin administered; client has history of anaphylaxis from penicillin - immunization for 3-month-old administered in ventrogluteal site - warfarin administered; client at 12 weeks gestation. 19) warfarin embryopathy - answer - warfarin crosses the placenta, resulting in fetal anticoagulation; dangerous fetal bleeding, including intracranial hemorrhage - warfarin is a teratogen and exposure during early pregnancy can result in fetal malformations 20) immunizations for children age 7 months - answer in the anterolateral thigh or vastus lateralis - the gluteus medius muscle (used for ventrogluteal injection) is developed through crawling and walking - the muscles are not developed enough at this age to be used as an acceptable site 21) a client with end-stage liver disease is admitted for a transplant workup. The client's spouse states that the client has not stopped drinking alcohol and may be unable to quit for 6 months before the transplant. Which is the most appropriate action for the nurse to implement? - ask the transplant team to place a palliative care referral so the client can learn about the option of hospice instead of transplant. - assess the client's motivation to make the necessary self-care changes before and after the transplant. - schedule a meeting to enlist the help of family members in encouraging the client to stay sober until the transplant. - tell the nurse manager that the client may not be an appropriate transplant candidate. - answer assess the client's motivation to make the necessary self-care changes before and after the transplant. 22) following the precipitous birth of a term newborn, what is the best action by the nurse while awaiting expulsion of the placenta and arrival of the health care provider? - clean the perineal area - gently pull on the cord - keep the infant warm - massage the fundus. - answer keep the infant warm . 23) precipitous birth - answer occurs when the newborn is delivered 3 or less hours after the onset of contractions. - immediately after the birth, the newborn should be dried and placed skin-to-skin on the mother's abdomen at uterine level to promote warmth; this prevents cold stress that can lead to newborn hypoglycemia or respiratory distress. - if the newborn is stable, the cord can be clamped and cut with sterile scissors after it has stopped pulsating or after the placenta has been expelled. 24) the health care provider orders a small bowel follow-through (sbft) for a client. Which instructions should the nurse include when teaching the client about his test? - "after the test, you may notice your stools are tarry black for a few days. - "during the test, a series of x-rays will be taken to asses the function of the small bowel." - "the hcp will use an endoscope to visualize your small bowel." - "your examination is scheduled for 8:00 am. Please drink all of the polyethylene glycol by midnight." - answer "during the test, a series of x-rays will be taken to assess the function of the small bowel." 25) small bowel follow-up (sbft) - answer examines the anatomy and function of the small intestine using x-ray images taken in succession. Barium is ingested, and x-ray images are taken every 15-60 minutes to visualize the barium as it passes through the small intestine. Using this technique, decreased motility, increased motility, fistulas, or obstructions are identified. 26) small bowel follow-up sbft patient instructions - answer - fast 8 hours prior to the examination - the test usually takes 60-120 minutes, but if obstruction or decreased motility is present, is can take longer. - drink plenty of fluids after the examination to facilitate barium removal. Chalky stools may be present 24-72 hours after the exam. If brown stools do not return after 72 hours or abdominal pain or fullness is present, contact the hcp 27) the parent of a 6-year-old calls the nurse and reports that the child was playing outside in the snow and the child's feet now appear red and swollen. What is the best response by the nurse? - "bring the child to the health care provider's (hcp) office immediately. - "give your child something warm to drink." - "massage the child's feet gently until they warm up." - "place the child's feet in warm water immediately." - answer "place the child's feet in warm water immediately." - the recommendation for re-warming is immersion of the affected area in warm water (104f) for about 30 minutes or until the area turns pink in cases of frostbite. 28) cold injury - answer clinical indications: redness and swelling of the skin - chilblains or pernio Blanched skin with hardness of the affected area - frostbit - it is important to re-warm the area as soon as possible to restore blood flow and reduce the risk of permanent tissue damage. - massaging a body part that has sustained a cold injury is contraindicated due to the risk of tissue injury. 29) the nurse prepares to administer a cleansing enema to a client with constipation. Which interventions are appropriate? Select all that apply. - assist the client into left lateral position with right knee flexed. - encourage the client to retain the enema for as long as possible. - insert tubing into the rectum with the tip directed toward the umbilicus. - keep the enema solution refrigerated until ready to administer. - slow administration rate if the client reports abdominal cramping. - answer - assist the client into left lateral position with right knee flexed. - encourage the client to retain the enema for as long as possible. - insert the tubing into the rectum with the tip directed toward the umbilicus - slow administration rate if the client reports abdominal cramping 30) cleansing enemas - answer normal saline, soapsuds, tap water - to relieve constipation - place the client in a left lateral position with the right knee flexed to promote the flow of the enema into the colon - hang the enema bag no more than 12 in above the rectum - lubricate the enema tubing tip and gently insert 3-4 in into the rectum. - direct the tubing tip toward the umbilicus during insertion to prevent intestinal perforation - open the roller clamp on the tubing to allow the solution to flow in by gravity. If the client reports abdominal cramping, use the roller clamp to slow the rate of administration. - fluid administered at room temperature or warmed, as cold enema solutions cause intestinal spasms and painful cramping. 31) the clinic nurse performs assessment on four infants. The nurse should alert the health care provider to see which client first? - 3-month-old whose posterior occiput appears flattened - 4-month-old who has sclera visible above the iris (sunset eyes) - 6-month-old who has vomited twice and has had 8 wet diapers in the last 24 hours - 9-month old whose toes fan out and big toe dorsiflexes when plantar surface is stroked. - answer - 4-month old who has sclera visible above the iris (sunset eyes) - signs of increased icp in children include bulging fontanelles, increasing head circumference, and sunset eyes 32) hydrocephalus - answer an increase in intracranial pressure that results from obstruction of cerebrospinal fluid flow. Can lead to brain damage and death 33) sunset eyes - answer occurs when periaqueductal structures are compressed from increased icp, paralyzing the upward gaze. Is a late sign of increased icp that requires timely treatment 34) the office nurse, while reviewing a client's health information, notices that the client has recently started taking st. John's wort for symptoms of depression. What additional information is most important for the nurse to obtain? - ask if the client is currently taking any prescription antidepressant medications - ask if the client has been diagnosed with depression by a mental health care provider - ask if the client takes a multivitamin with iron - ask if the client uses tanning beds. - answer ask if the client is currently taking any prescription antidepressant medications - st john's wort tends to increase side effects of antidepressants, ssris, snris, and maois, and could potentially lead to serotonin syndrome 35) serotonin syndrome - answer mild symptoms: shivering and diarrhea Severe: muscle rigidity, fever, seizures, death 36) a nurse is caring for a 2-year-old child diagnosed with nephrotic syndrome who is in diapers and has red, edematous genitals. Which collection technique is appropriate for the nurse to obtain daily urine specimens for proteinuria testing with a urine dipstick? - apply adhesive urine collection bag around the genital area and wait for the child to void - intermittently catheterize the child every morning to avoid contaminating the specimen - place cotton balls in a dry diaper; when wet, squeeze urine onto dipstick - place urine dipstick in the child's diaper overnight and check result in the morning. - answer place cotton balls in a dry diaper; when wet, squeeze urine onto dipstick - sample will be nonsterile! 37) nephrotic syndrom - answer characterized by massive proteinuria and hypoalbuminemia, which results in severe edema most evident in the abdomen, face, and perineum. 38) Daily urinalysis determines the presence and pattern of urine protein loss to monitor for exacerbations. 39) the parents of a 4-year-old tell the nurse that the child won't go to sleep at night due to fear of tigers living under the bed. Which response by the nurse is most helpful? - "have you recently visited the zoo? Maybe the tigers looked scary." - "if you agree with your child, the fears could continue through this developmental stage.." - "night fears are common at this stage. Look under the bed with your child." - "this is very unusual. Maybe the child saw something scary on tv." - answer "night fears are common at this age. Look under the bed with your child." 40) the nurse is caring for a client who weighs 450 lb (204.1 kg) 2 days after bariatric surgery. The client is pleasant, cooperative, and able to fully bear weight. What would be the most appropriate method for transferring this client safely? - 1-person safety standby with walker - 2-person full-body sling lift - 2 person standing-assist lift - 4-person full-body sling lift. - answer 1-person safety standby with walker 41) the charge nurse in the medical-surgical unit is evaluating client safety. Which actions by unlicensed assistive personnel (uap) would require the nurse to intervene? Select all that apply. - 1 uap repositioning a client who is 8 hours postoperative total hip replacement - 1 uap using a gait belt to transfer a partial weight-bearing client from the bed to a chair. - 2 uaps repositioning a client who is sedated and has been on the left side for 2 hours - 2 uaps using the log-rolling technique to move a client with a cervical collar. - 3 uaps using a draw sheet to move a client who weighs 220 lb (100 kg) up in bed. - answer - 1 uap repositioning a client who is 8 hours postoperative total hip replacement - 2 uaps using the log-rolling technique to move a client with a cervical collar. 42) which situations require that the registered nurse (rn) report to an appropriate authority? Select all that apply. - client has a row of 3-inch circles down the back from "cupping." - client is diagnosed with gonorrhea and requests not to report under the health insurance portability and accountability act (hippa) - rn thinks a teenage client's signs are from abuse, but the hcp does not - rn thinks an elderly client's signs are from abuse but the client denies this. - syphilis is diagnosed in an 11-year-old who denies sexual activity - answer - client is diagnosed with gonorrhea and requests not to report under the hippa - rn thinks a teenage client's signs are from abuse but the health care provider does not - rn thinks an elderly client's signs are from abuse but the client denies this - syphilis is diagnosed in an 11-year-old who denies sexual activity 43) the nurse has just received report. Which client should the nurse assess first? - client admitted from coronary angiography in the past hour with back pain - client with a deep vein thrombosis (dvt) on heparin drip at 1250 units/hr with an activated thromboplastin time (aptt) of 60 seconds - client with a head injury and a glasgow coma scale of 14 - postoperative day 2 coronary artery bypass graft client with incisional pain rated 6 on pain scale. - answer client admitted from coronary angiography in the past hour with back pain - any report of back or flank pain should be assessed for possible retroperitoneal bleeding as back pain, tachycardia, and hypotension may be the only indication of internal bleeding 44) a nurse is providing anticipatory guidance to a client with early alzheimer disease and osteoarthritis. Current symptoms include mild forgetfulness and cognition changes. Which is the best example of an educational goas for anticipatory guidance? - the client will demonstrate proper organization of medications in a weekly pill box by the end of the teaching session - the client will identify and attend a support group meeting for clients with dementia by the end of the month - the client will verbalize 2 home safety changes that can prevent falls during disease progression by the end of the session - the client will verbalize 3 example of easy, nutritious meals that can be prepared independently by the end of the clinic visit. - answer the client will verbalize 2 home safety changes that can prevent falls during disease progression by the end of the session 45) the nurse is caring for an infant with suspected meningitis and preparing to assist with a lumbar puncture. What is the appropriate nursing intervention? - administer oxygen via nasal cannula for client comfort and safety - clean area with povidone iodine in a circular motion moving outward. - hold the child with the head and knees tucked in and the back rounded out - monitor and record vital signs every 15 minutes throughout the procedure. - answer hold the child with the head and knees tucked in and the back rounded