NCLEX 3500 Quiz

July 26, 2019

A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every two hours. Which of the following outcome criteria would the nurse use?

Body temperature of 99°F or less

Toes moved in active range of motion

Sensation reported when soles of feet are touched

Capillary refill of < 3 seconds

Correct! Wrong!

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The first action that the nurse should take if she finds the client has an O2 saturation of 68% is:

Elevate the head.

Recheck the O2 saturation in 30 minutes.

Apply oxygen by mask.

Assess the heart rate.

Correct! Wrong!

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Which of the following foods, if selected by the mother with a child with celiac, would indicate her understanding of the dietary instructions?

Whole-wheat toast

Angel hair pasta

Reuben on rye

Rice cereal

Correct! Wrong!

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A 25-year-old client with a goiter is admitted to the unit. What would the nurse expect the admitting assessment to reveal?

Bulging eyes

Slow pulse

Weight gain

Anorexia

Correct! Wrong!

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What would the nurse expect the admitting assessment to reveal in a client with glomerulonephritis?

Fatigue

Hypertension

Lassitude

Vomiting and diarrhea

Correct! Wrong!

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The client has an order for sliding scale insulin at 1900 hours and Lantus insulin at the same hour. The nurse should:

Administer the two medications together.

Administer the medications in two injections.

Draw up the Lantus insulin and then the regular insulin and administer them together.

Contact the doctor because these medications should not be given to the same client.

Correct! Wrong!

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A client with AIDS has a viral load of 200 copies per ml. The nurse should interpret this finding as:

The client is no longer communicable.

The client is at risk for opportunistic diseases.

The client’s T-cell count is extremely low

The client’s viral load is extremely low so he is relatively free of circulating virus.

Correct! Wrong!

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Before administering eardrops to a toddler, the nurse should recognize that it is essential to consider which of the following?

The age of the child

The child's weight

The developmental level of the child

The IQ of the child

Correct! Wrong!

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The emergency room is flooded with clients injured in a tornado. Which clients can be assigned to share a room in the emergency department during the disaster?

A child who is cyanotic with severe dypsnea and a client with a frontal head injury

The client who is pregnant and the client with a broken arm

A client having auditory hallucinations and the client with ulcerative colitis

The client who arrives with a large puncture wound to the abdomen and the client with chest pain

Correct! Wrong!

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The home health nurse is planning for the day’s visits. Which client should be seen first?

The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter

The five-month-old discharged one week ago with pneumonia who is being treated with amoxicillin liquid suspension

The 78-year-old who had a gastrectomy three weeks ago and has a PEG tube

The 50-year-old with MRSA being treated with Vancomycin via a PICC line

Correct! Wrong!

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A female client is scheduled to receive a heart valve replacement with a porcine valve. Which of the following types of transplant is this?

Allogeneic

Autologous

Syngeneic

Xenogeneic

Correct! Wrong!

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The nurse knows that neurologic complications of multiple myeloma (MM) usually involve which of the following body system?

Brain

Muscle spasm

Renal dysfunction

Myocardial irritability

Correct! Wrong!

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Which of the following laboratory test results would suggest to the nurse Len that a client has a corticotropin-secreting pituitary adenoma?

High corticotropin and low cortisol levels

Low corticotropin and high cortisol levels

High corticotropin and high cortisol levels

Low corticotropin and low cortisol levels

Correct! Wrong!

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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?

Elevated serum acetone level

Serum ketone bodies

Serum alkalosis

Below-normal serum potassium level

Correct! Wrong!

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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?

Asthma attack

Atelectasis

Bronchitis

Fat embolism

Correct! Wrong!

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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?

"I will wear the stockings until the physician tells me to remove them."

"I should wear the stockings even when I am asleep."

"Every four hours I should remove the stockings for a half hour."

"I should put on the stockings before getting out of bed in the morning."

Correct! Wrong!

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A patient arrives in the emergency department and reports splashing concentrated household cleaner in his eye. Which of the following nursing actions is a priority?