NCLEX-RN Dumps PDF New [2023] Ultimate Study Guide
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Understand the topics of the NCLEX-RN Exam.
The certification topics of NCLEX-RN Exam
- High Risk Behaviors, and Self-Care.
- Disease Prevention
- Health Promotion Programs
- Aging Process
- Developmental Stages and Transitions
- Lifestyle Choices
NEW QUESTION 458
The physician orders medication for a client's unpleasant side effects from the haloperidol. The most appropriate drug at this time is:
- A. Lorazepam
- B. Triazolam (Halcion)
- C. Thiothixene
- D. Benztropine
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Lorazepam is a benzodiazepine, or antianxiety agent, that potentiates the effects of _-aminobutyric acid in the CNS, which is not the CNS neurotransmitter EPS. (B) Triazolam is a benzodiazepine sedative- hypnotic whose action is mediated in the limbic, thalamic, and hypothalamic levels of the CNS by ў- aminobutyric acid. (C) Benztropine is an anticholinergic agent, and the drug of choice for blocking CNS synaptic response, which causes EPS. (D) Thiothixene is an antipsychotic and neuroleptic drug that blocks dopamine neurotransmission at the CNS synapses, thereby causing EPS.
NEW QUESTION 459
A male client has asthma and his physician has prescribed beclomethasone (Vanceril) 3 puffs tid in addition to his other medications. After taking his beclomethasone, the client should be instructed to:
- A. Clean his inhaler with warm water and soak it in a 10% bleach solution
- B. Use his bronchodilator inhaler
- C. Drink a glass of water
- D. Sit and rest
Answer: C
Explanation:
(A) Inhalers should be cleaned once a day. They should be taken apart, washed in warm water, and dried according to manufacturer's instructions. Soaking in bleach is inappropriate. (B) A common side effect of inhaled steroid preparations is oral candidal infection. This can be prevented by drinking a glass of water or gargling after using a steroid inhaler. (C) There is nothing wrong with sitting and resting after using a steroid inhaler, but it is not necessary. (D) If a person is using a steroid inhaler as well as a bronchodilator inhaler, the bronchodilator shouldalways be used first. The reason for this is that the bronchodilator opens up the person's airways so that when the steroid inhaler is used next, there will be better distribution of medication.
NEW QUESTION 460
At 30 weeks' gestation, a client is admitted to the unit in premature labor. Her contractions are every 5 minutes and last 60 seconds, her cervix is closed, and the suture placed
around her cervix during her 16th week of gestation, when she had the MacDonald procedure, can still be felt by the physician. The amniotic sac is still intact. She is very concerned about delivering prematurely. She asks the RN, "What is the greatest risk to my baby if it is born prematurely?" The RN's answer should be:
- A. Lack of development of the intestines
- B. Lack of development of the lungs
- C. Hyperglycemia
- D. Hypoglycemia
Answer: B
Explanation:
(A)
Any infant would be at risk for hyperglycemia because the infant's liver is missing the islets of Langerhans, which secrete insulin to break down glucose for cellular use. Prematurity is not an added risk for hyperglycemia. (B) Both premature and mature infants can be at risk for hypoglycemia if their mother had gestational diabetes during pregnancy or entered the pregnancy with diabetes mellitus. These infants are exposed to high levels of maternal glucose while in utero, which causes the islets of Langerhans in the infant's liver to produce insulin. After birth when the umbilical cord is severed, the generous amount of maternal blood glucose is eliminated; however, there is continued islet cell hyperactivity in the infant's liver, which can lead to excessive insulin levels and depleted blood glucose.
(C)
Mature infants are born with an immature GI system. The nervous control of the stomach is incomplete at birth, salivary glands are immature at birth, and the intestinal tract is sterile. This is not the greatest risk to the premature infant. (D) Infants born before 37 weeks' gestation are at greatest risk for an insufficient amount of surfactant in the alveoli system of the lungs. Surfactant helps to prevent lung collapse and ensures stability of the respiratory system so that the infant can maintain his own respirations once the umbilical cord is severed at birth.
NEW QUESTION 461
A client is dilated 8 cm and entering the transition phase of labor. Common behaviors of the laboring woman during transition are:
- A. Frustration, vague in communication
- B. Calmness, follows directions easily
- C. Seriousness, some difficulty following directions
- D. Excitement, openness to instructions
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) During the transition phase, the mother may become frustrated and unclear in her communication owing to severe pain and fear of loss of control. (B) These behaviors are common in the active phase of labor. (C) These behavioral clues are seen in the latent phase of labor. (D) These characteristics are observed in the latent phase of labor.
NEW QUESTION 462
Before giving methergine postpartum, the nurse should assess the client for:
- A. Decreased amount of lochial flow
- B. Flushing
- C. Elevated blood pressure
- D. Afterpains
Answer: C
Explanation:
Explanation
(A) Methergine is given to contract the uterus and to control postpartal hemorrhage; therefore, lochial flow should decrease. (B) Methergine may elevate the blood pressure. A client with an elevated blood pressure should not receive methergine, but she could be given oxytocin if necessary. (C) Flushing is not a side effect of methergine. (D) Afterpains are increased with methergine usage. The client should be informed that this is a normal response.
NEW QUESTION 463
A client has received digoxin 0.25 mg po daily for 2 weeks. Which of the following digoxin levels indicates toxicity?
- A. 1.0 ng/mL
- B. 2.0 ng/mL
- C. 0.5 ng/mL
- D. 3.0 ng/mL
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) 0.5 ng/mL of digoxin is a subtherapeutic level, not a toxic one. (B) 1.0 ng/mL is a therapeutic level. (C)
2.0 ng/mL is a therapeutic level. (D) Digoxin's therapeutic level is 0.8-2.0 ng/mL. Digoxin's toxic level is
>2.0 ng/mL.
NEW QUESTION 464
A female client admitted to the labor and delivery unit thinks her bag of water "broke" approximately 2 hours ago. She is having mild contractions 5 minutes apart. The most immediate nursing intervention would be to:
- A. Note the color and amount of fluid on her clothes.
- B. Notify the physician.
- C. Assess the FHR.
- D. Place the nitrazine test paper at the cervical os and note the color change.
Answer: C
Explanation:
Explanation
(A) Amniotic fluid is generally pale and straw colored. Meconium- stained amniotic fluid would indicate a previous hypoxic episode. This intervention, though appropriate, is not the immediate priority. (B) With rupture of the membranes, the umbilical cord may prolapse if the presenting part does not fill the pelvis.
Assessing FHR ascertains fetal well-being. (C) More information regarding fetal status and assessing for membrane rupture is needed prior to contacting the physician. (D) Nitrazine test paper differentiates amniotic fluid from urine. Amniotic fluid is normally alkaline in contrast to urine, which is acidic. This intervention, though appropriate, is not the immediate priority.
NEW QUESTION 465
A 6-month-old infant who was diagnosed at 4 weeks of age with a ventricular septal defect, was admitted today with a diagnosis of failure to thrive. His mother stated that he had not been eating well for the past month. A cardiac catheterization reveals congestive heart failure. All of the following nursing diagnoses are appropriate. Which nursing diagnosis should have priority?
- A. Activity intolerance related to imbalance between oxygen supply and demand
- B. Altered nutrition: less than body requirements related to inability to take in adequate calories
- C. Altered growth and development related to decreased intake of food
- D. Decreased cardiac output related to ineffective pumping action of the heart
Answer: D
Explanation:
(A) Altered nutrition occurs owing to the fatigue from decreased cardiac output associated with congestive heart failure. (B) The decreased intake occurs due to fatigue from the altered cardiac output. (C) Fatigue occurs due to the decreased cardiac output. (D) The ineffective action of the myocardium leads to inadequate O2 to the tissues, which produces activity intolerance, altered nutrition, and altered growth and development.
NEW QUESTION 466
The nurse is caring for a laboring client. Assessment data include cervical dilation 9 cm; contractions every
1-2 minutes; strong, large amount of "bloody show." The most appropriate nursing goal for this client would be:
- A. Enlist additional caregiver support to ensure client's safety.
- B. Maintain client's privacy.
- C. Assist with assessment procedures.
- D. Provide strategies to maintain client control.
Answer: D
Explanation:
Explanation
(A) Privacy may help the laboring client feel safer, but measures that enhance coping take priority. (B) The frequency of assessments do increase in transition, but helping the client to maintain control and cope with this phase of labor takes on importance. (C) This laboring client is in transition, the most difficult part of the first stage of labor because of decreased frequency, increased duration and intensity, and decreased resting phase of the uterine contraction. The client's ability to cope is most threatened during this phase of labor, and nursing actions aredirected toward helping the client to maintain control. (D) Safety is a concern throughout labor, but helping the client to cope takes on importance in transition.
NEW QUESTION 467
A client calls the prenatal clinic to schedule an appointment. She states she has missed three menstrual periods and thinks she might be pregnant. During her first visit to the prenatal clinic, it is confirmed that she is pregnant. The registered nurse (RN) learns that her last menstrual period began on June 10. According to Nagele's rule, the estimated date of confinement is:
- A. August 30
- B. June 3
- C. January 10
- D. March 17
Answer: D
Explanation:
(A) Using Nagele's rule, count back 3 calendar months from the first day of the last menstrual period. The answer is March 10. Then add 7 days and 1 year, which would be March 17 of the following year. (B, C, D) This date is incorrect.
NEW QUESTION 468
A schizophrenic is admitted to the psychiatric unit. What affect would the nurse expect to observe?
- A. Anger
- B. Apathy and flatness
- C. Smiling
- D. Hostility
Answer: B
Explanation:
(A) Anger is an emotion that is not necessarily present in schizophrenia. (B) Lack of response to or involvement with environment and distancing are characteristic of schizophrenia. (C) Euphoria is more characteristic of manic-depressive disorder (bipolar disorder). (D) Hostility is an emotion that is not necessarily present in schizophrenia.
NEW QUESTION 469
A successful executive left her job and became a housewife after her marriage to a plastic surgeon. She started doing volunteer work for a charity organization. She developed pain in her legs that advanced to the point of paralysis. Her physicians can find no organic basis for the paralysis. The client's behavior can be described as:
- A. Housework phobia
- B. Malingering
- C. Conversion reaction
- D. Agoraphobia
Answer: C
Explanation:
Section: Questions Set D
Explanation:
(A) A typical phobia does not result in physical symptoms (i.e., paralysis). (B) Malingering is pretending to be ill.
This person has a true paralysis. (C) A conversion reaction is a physical expression of an emotional conflict. It has no organic basis. (D) Agoraphobia is fear of public places.
NEW QUESTION 470
The nurse in the mental health center is instructing a depressed client about the dietary restrictions necessary in taking her medication, which is a monoamine oxidase (MAO) inhibitor. Which of the following is she restricting from the client's diet?
- A. Fresh fruits
- B. Yeast bread
- C. Aged cheese
- D. Cream cheese
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) Cream cheese does not contain tyramine, which might cause a hypertensive crisis. (B) Fresh fruits do not contain tyramine, which might cause a hypertensive crisis. (C) Aged or matured cheese combined with a monoamine oxidase predisposes the client to a hypertensive crisis. (D) Bread products raised with yeast do not contain tyramine.
NEW QUESTION 471
The physician prescribes amitriptyline (Elavil) for a client. What does the patient need to know about this medication?
- A. Prolonged use of this medication will result in extrapyramidal side effects.
- B. When the medication is effective, he will experience no anxiety.
- C. Blood must be drawn weekly to test for toxicity.
- D. The medication should relieve his symptoms of depression.
Answer: D
Explanation:
Explanation
(A) Phenothiazines cause extrapyramidal symptoms. (B) No amount of medication can relieve all anxiety in all cases. (C) The purpose of amitriptyline is to relieve the symptoms of depression because it is an antidepressant. It increases the action of norepinephrine and serotonin on nerve cells. (D) Periodic blood tests are done when lithium is prescribed.
NEW QUESTION 472
A 44-year-old female client is receiving external radiation to her scapula for metastasis of breast cancer.
Teaching related to skin care for the client would include which of the following?
- A. Encourage her to wear a tight-fitting vest to support her scapula.
- B. Teach her to completely clean the skin to remove all ointments and markings after each treatment.
- C. Encourage her to avoid direct sunlight on the area being treated.
- D. Teach her to cover broken skin in the treated area with a medicated ointment.
Answer: C
Explanation:
(A) The skin in a treatment area should be rinsed with water and patted dry. Markings should be left intact, and the skin should not be scrubbed. (B) Clients should avoid putting any creams or lotions on the treated area. This could interfere with treatment. (C) Radiation therapy clients should wear loose-fitting clothes and avoid tight, irritating fabrics. (D) The area of skin being treated is sensitive to sunlight, and the client should take care to prevent sun damage by avoiding direct sunlight and covering the area when she is in the sun.
NEW QUESTION 473
A 12-year-old girl has been diagnosed with insulindependent diabetes mellitus. Which of these principles would best guide her nutritional management?
- A. Food restriction is imposed to reduce weight.
- B. Concentrated sweets are taken during increased activity.
- C. Caloric distribution should be calculated to fit activity patterns.
- D. Fat requirements are increased owing to the possibility of ketoacidosis.
Answer: C
Explanation:
Section: Questions Set E
Explanation:
(A) Concentrated sweets are eliminated from diet planning. Complex carbohydrates may be taken at the time of increased activity. (B) Food restriction is not used for diabetic control of growing children. Caloric restriction may be imposed for weight control if necessary. (C) Total caloric intake and proportions of basic nutrients should be consistent from day to day. Distribution of these calories should fit the activity pattern. Extra food is needed for increased activity. A balance of food, exercise, and insulin should be maintained. (D) Because of the increased risk of atherosclerosis, the fat percentage of the total caloric intake is reduced.
NEW QUESTION 474
A client at 6 months' gestation complains of tiredness and dizziness. Her hemoglobin level is 10 g/dL, and her hematocrit value is 32%. Her nutritional intake is assessed as sufficient. The most likely diagnosis is:
- A. No problem indicated
- B. Iron-deficiency anemia
- C. Physiological anemia
- D. Fatigue due to stress
Answer: B
Explanation:
(A) This clinical situation is indicative of iron-deficiency anemia because the client has inadequate nutritional intake. Her blood volume is increasing faster than her red blood cell volume. Anemia is present in the second trimester when the hemoglobin level is <10.5 and the hematocrit value falls below 35%. She needs increased iron supplements with follow-up. (B) The client's values are below levels for physiological anemia. (C) The client is fatigued because of a low hemoglobin level. (D) Her hemoglobin level is low and will probably decrease even more when the blood volume peaks at 28 weeks.
NEW QUESTION 475
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. Lecithin-sphingomyelin ratio
- C. Blood serum phenylalanine test
- D. Metachromatic stain
Answer: B
Explanation:
Section: Questions Set D
Explanation
Explanation:
(A) Dinitrophenylhydrazine is a laboratory test used to detect phenylketonuria, maple syrup urine disease, and Lowe's syndrome. (B) Metachromatic stain is a laboratory test that may be used to diagnose Tay-Sachs and other lipid diseases of the central nervous system. (C) The blood serum phenylalanine test is diagnostic of phenylketonuria and can be used for wide-scale screening. (D) A lecithin-sphingomyelin ratio of at least 2:1 is indicative of fetal lung maturity, and survival of the fetus is likely.
NEW QUESTION 476
A young child has been placed in a spica cast. The chief concern of the nurse during the first few hours is:
- A. Using heated fans to dry the cast
- B. Prevention of loss of muscle tone
- C. Prevention of neurovascular complications
- D. Immobilization of the affected limb
Answer: C
Explanation:
Explanation
(A) Because the extremity may continue to swell and the cast could constrict circulation, the nurse should elevate the limb and observe for capillary refill, warmth, mobility of toes and circulation. (B) Although muscle tone may diminish over time in the affected limb, this is not the immediate concern. (C) The limb has been immobilized already by the cast, and therefore immobilization is not a concern. (D) Heated fans and dryers are discouraged because the outside cast will dry quickly, yet the area beneath the cast remains wet and could cause burns.
NEW QUESTION 477
The nurse working in a prenatal clinic needs to be alert to the cardinal signs and symptoms of PIH because:
- A. Psychological counseling is indicated to reduce the emotional stress causing the blood pressure elevation
- B. The client may not recognize the early symptoms of PIH
- C. Self-discipline is required to control caloric intake throughout the pregnancy
- D. Immediate treatment of mild PIH includes the administration of a variety of medications
Answer: B
Explanation:
Explanation
(A) Mild PIH is not treated with medications. (B) Emotional stress is not the cause of blood pressure elevation in PIH. (C) Excessive caloric intake is not the cause of weight gain in PIH. (D) The client most frequently is not aware of the signs and symptoms in mild PIH.
NEW QUESTION 478
A 56-year-old client is admitted to the psychiatric unit in a state of total despair. She feels hopeless and worthless, has a flat affect and very sad appearance, and is unable to feel pleasure from anything. Her husband has been assisting her at home with the housework and cooking; however, she has not been eating much, lies around or sits in a chair most of the day, and is becoming confused and thinks her family does not want her around anymore. In assessing the client, the nurse determines that her behavior is consistent with:
- A. Severe depression
- B. Transient depression
- C. Moderate depression
- D. Mild depression
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Transient depression manifests as sadness or the "blues" as seen with everyday disappointments and is not necessarily dysfunctional. (B) Mild depression manifests as symptoms seen with grief response, such as denial, sadness, withdrawal, somatic symptoms, and frequent or continuous thoughts of the loss.
(C) Moderate depression manifests as feelings of sadness, negativism; low self-esteem; rumination about life's failures; decreased interest in grooming and eating; and possibly sleep disturbances. These symptoms are consistent with dysthymia. (D) Severe depression manifests as feelings of total despair, hopelessness, emptiness, inability to feel pleasure; possibly extreme psychomotor retardation; inattention to hygiene; delusional thinking; confusion; self-blame; and suicidal thoughts. These symptoms are consistent with major depression.
NEW QUESTION 479
In addition to changing the mother's position to relieve cord pressure, the nurse may employ the following measure (s) in the event that she observes the cord out of the vagina:
- A. Keep the cord warm and moist by continuous applications of warm, sterile saline compresses.
- B. Immediately pour sterile saline on the cord, and repeat this every 15 minutes to prevent drying.
- C. Cover the cord with a wet sponge.
- D. Apply a cord clamp to the exposed cord, and cover with a sterile towel.
Answer: A
Explanation:
Section: Questions Set B
Explanation:
(A) Saline should be warmed; waiting 15 minutes may not keep the cord moist. (B) This choice does not specify what the sponge was "wet" with. (C) This measure would stop circulation to the fetus. (D) The cord should be kept warm and moist to maintain fetal circulation. This measure is an accepted nursing action.
NEW QUESTION 480
A client is having an amniocentesis. Prior to the procedure, an ultrasound is performed. In preparing the client, the nurse explains the reason for a sonogram in this situation to be:
- A. Determination of gross anomalies
- B. Determination of fetal age
- C. Determination of multiple gestations
- D. Determination of placental location
Answer: D
Explanation:
Explanation
(A) Sonography can be used to determine the presence of multiple gestation. In this question, the sonogram is used as a preparatory step for a specific invasive procedure. (B) Sonography can be used to determine the presence of gross anomalies. In this question, the sonogram is used as a preparatory step for a specific invasive procedure. (C) Prior to amniocentesis, the abdomen is scanned by ultrasound to locate the placenta, thus reducing the possibility of penetrating it with the spinal needle used to obtain amniotic fluid. (D) Sonography can be used to determine fetal age. In this question, the sonogram is used as a preparatory step for a specific invasive procedure.
NEW QUESTION 481
A child sustains a supracondylar fracture of the femur. When assessing for vascular injury, the nurse should be alert for the signs of ischemia, which include:
- A. Pain, pallor, pulselessness, paresthesia, and paralysis
- B. Bleeding, bruising, and hemorrhage
- C. Generalized swelling, pain, and diminished functional use with muscle rigidity and crepitus
- D. Increase in serum levels of creatinine, alkaline phosphatase, and aspartate transaminase
Answer: A
Explanation:
Explanation
(A) Bleeding, bruising, and hemorrhage may occur due to injury but are not classic signs of ischemia. (B) An increase in serum levels of creatinine, alkaline phosphatase, and aspartate transaminase is related to the disruption of muscle integrity. (C) Classic signs of ischemia related to vascular injury secondary to long bone fractures include the five "P's": pain, pallor, pulselessness, paresthesia, and paralysis. (D) Generalized swelling, pain, and diminished functional use with muscle rigidity and crepitus are common clinical manifestations of a fracture but not ischemia.
NEW QUESTION 482
The nurse is preparing a 6-year-old child for an IV insertion. Which one of the following statements by the nurse is appropriate when preparing a child for a potentially painful procedure?
- A. "This will hurt only a little; try to be a big boy."
- B. "This is going to hurt a lot; close your eyes and hold my hand."
- C. "This is a terrible procedure, so don't look."
- D. "Some say this feels like a pinch or a bug bite. You tell me what it feels like."
Answer: D
Explanation:
Section: Questions Set B
Explanation:
(A) Educating the child about the pain may lessen anxiety. The child should be prepared for a potentially painful procedure but avoid suggesting pain. The nurse should allow the child his own sensory perception and evaluation of the procedure. (B) The nurse should avoid absolute descriptive statements and allow the child his own perception of the procedure. (C) The nurse should avoid evaluative statements or descriptions and give the child control in describing his reactions. (D) False statements regarding a painful procedure will cause a loss of trust between the child and the nurse.
NEW QUESTION 483
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The Average salary of different countries of NCLEX-RN Certified professional
- UK - 44352.90 Pounds
- India - 4461870 INR
- United States - 60,000 USD
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