2023 100% Free NCLEX-RN Daily Practice Exam With 865 Questions
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NEW QUESTION # 378
The most frequent cause of early postpartum hemorrhage is:
- A. Coagulation disorders
- B. Hematoma
- C. Retained placental fragments
- D. Uterine atony
Answer: D
Explanation:
Explanation
(A) Hematomas, which are the result of damage to a vessel wall without laceration of the tissue, are a cause, though not the most frequent cause. (B) Coagulation disorders are among the causes of postpartal hemorrhage, but they are less common. (C) The most frequent causes of hemorrhage in the postpartal period are related to an interference with involution of the uterus. Uterine atony is the most frequent cause, occurring in the first 24 hours after delivery. (D) Retained placental fragments are also a cause, although these bleeds usually occur
7-14 days after delivery.
NEW QUESTION # 379
A complication for which the nurse should be alert following a liver biopsy is:
- A. Ascites
- B. Jaundice
- C. Hepatic coma
- D. Shock
Answer: D
Explanation:
Explanation
(A) Hepatic coma may occur in liver disease due to the increased NH3levels, not due to liver biopsy. (B) Jaundice may occur due to increased bilirubin levels, not due to liver biopsy. (C) Ascites would occur due to portal hypertension, not due to liver biopsy. (D) Hemorrhage and shock are the most likely complications after liver biopsy because of already existing bleeding tendencies in the vascular makeup of the liver.
NEW QUESTION # 380
The nurse is collecting a nutritional history on a 28- year-old female client with iron-deficiency anemia and learns that the client likes to eat white chalk. When implementing a teaching plan, the nurse should explain that this practice:
- A. Will cause more premenstrual cramping
- B. Will bind calcium and therefore interfere with its metabolism
- C. Interferes with iron absorption because the iron precipitates as an insoluble substance
- D. Causes competition at iron-receptor sites between iron and vitamin B1
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) Eating chalk is not related to calcium and its absorption. (B) Poor nutritional habits may result in increased discomfort during premenstrual days, but this is not a primary reason for the client to stop eating chalk. Premenstrual discomfort has not been mentioned. (C) Iron is rendered insoluble and is excreted through the gastrointestinal tract. (D) There is no competition between the two nutrients.
NEW QUESTION # 381
Prior to his discharge from the hospital, a cardiac client is started on digoxin (Lanoxin) 25 mg po qd. The nurse initiates discharge teaching. Which of the following statements by the client would validate an understanding of his medication?
- A. "I could stop taking this medication when I begin to feel better."
- B. "I should always take this medication with an antacid."
- C. "I would notify my physician immediately if I experience nausea, vomiting, and double vision."
- D. "I should only take the medication if my heart rate is greater than 100 bpm."
Answer: C
Explanation:
Section: Questions Set G
Explanation:
(A) The first signs of digoxin toxicity include abdominal pain, anorexia, nausea, vomiting, and visual disturbances. The physician should be notified if any of these symptoms are experienced. (B) The positive inotropic effects of digoxin increase cardiac output and result in an enhanced activity tolerance. "Feeling better" indicates the drug is working and medication therapy must be continued. (C) Clients should be taught to take their pulse prior to taking the digoxin. If their pulse rate becomes irregular, slows significantly, or is >100 bpm the physician should be notified. (D) Antacids decrease the effectiveness of digoxin.
NEW QUESTION # 382
A 55-year-old man has recently been diagnosed with hypertension. His physician orders a low-sodium diet for him. When he asks, "What does salt have to do with high blood pressure?'' the nurse's initial response would be:
- A. "Large amounts of salt in your diet can cause you to retain fluid, which increases your blood pressure."
- B. "The reason is not known why hypertension is associated with a high-salt diet."
- C. "Salt is needed to maintain blood pressure, but too much causes hypertension."
- D. "Salt affects your blood vessels and causes your blood pressure to be high."
Answer: A
Explanation:
(A) This response is untrue. (B) Decreasing salt intake reduces fluid retention and decreases blood pressure. (C) Salt does not have an effect on the blood vessels themselves, but on fluid retention, which accompanies salt intake. (D) This response is untrue.
NEW QUESTION # 383
In caring at home for a child who just ingested a caustic alkali, the nurse would immediately tell the mother to:
- A. Give vinegar, lemon juice, or orange juice
- B. Phone the doctor
- C. Induce vomiting
- D. Take the child to the emergency room
Answer: A
Explanation:
Explanation
(A) The immediate action is to neutralize the action of the chemical before further damage takes place. (B) This action should be done after neutralizing the chemical. (C) This action should be done after neutralizing the chemical. (D) Never induce vomiting with a strong alkali or acid. Additional damage will be done when the child vomits the chemical.
NEW QUESTION # 384
The postpartum nurse should include which of the following instructions to breast-feeding mothers?
- A. Daily caloric intake should be increased by 500 cal.
- B. Wash the nipples with soap and water before and after each feeding.
- C. Limit feeding times for several days to avoid nipple soreness.
- D. Breast milk is totally digestible by the baby because it contains lactose.
Answer: A
Explanation:
Explanation
(A) Limiting initial feeding times will only delay nipple soreness as well as the establishment of the letdown reflex, thus encouraging engorgement from clogged ducts and ductules. (B) Soap should be avoided because it may be excessively drying, predisposing nipples to cracking. (C) For optimal milk production, an additional
500 kcal over maintenance levels are needed daily. (D) Lipase, not lactose, emulsifies the fat in breast milk, making it almost totally digestible by infants.
NEW QUESTION # 385
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. Intermittently to place a pull over the pelvis and lower spine
- B. With weights at both ends of the bed to maintain pull on the upper extremity
- C. By inserting pins to provide steady pull on the bone
- D. To suspend the leg in a sling without pull on the extremity
Answer: C
Explanation:
Explanation
(A) Skeletal traction is the application of traction directly to bone with the use of pins and wires or tongs for the purpose of providing a strong, steady, continuous longitudinal pull on the bone. It is indicated for preoperative immobilization and positioning of hip and femur fractures. (B) A type of skeletal traction (balanced suspension with a Thomas splint and Pearson attachment) uses a sling to support the extremity, but it also uses weights to provide a strong, steady continuouspull on the extremity. A sling is used instead of pins.
(C) Pelvic traction provides an intermittent pull over the pelvis and bone, whereas skeletal traction is continuous. Pelvic traction does not use pins. (D) Skeletal traction uses weights at the end of the bed to provide a continuous pull on long bones. Weights are not applied to both ends of the bed.
NEW QUESTION # 386
The physician orders haloperidol 5 mg IM stat for a client and tells the nurse that the dose can be repeated in
1-2 hours if needed. The most likely rationale for this order is:
- A. Rapid neuroleptization is the most effective approach to care for the violent or potentially violent client
- B. Haloperidol is a minor tranquilizer and will not oversedate the client
- C. The medication will sedate the client until the physician arrives
- D. The client will settle down more quickly if he thinks the staff is medicating him
Answer: A
Explanation:
Section: Questions Set G
Explanation:
(A) If the client could think logically, he would not be paranoid. In fact, he is probably suspicious of the staff, too. Newly admitted clients frequently experience high levels of anxiety, which can contribute to delusions. (B) The goal of pharmacological intervention is to calm the client and assist with reality-based thinking, not to sedate him. (C) Haloperidol is a neuroleptic and antipsychotic drug, not a minor tranquilizer. (D) Haloperidol is a high-potency neuroleptic and first-line choice for rapid neuroleptization, with low potential for sedation.
NEW QUESTION # 387
A client is being discharged from the hospital tomorrow following a colon resection with a left colostomy.
The nurse knows that the client understands the discharge teaching about care of her colostomy when she says:
- A. "I know that I am not supposed to irrigate my colostomy."
- B. "My stoma should be red and slightly raised."
- C. "The skin around my stoma may become irritated from the enzymes in my stool."
- D. "My stool will be soft like paste."
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) A left colostomy indicates an ascending colon resection. This type of colostomy can be irrigated. (B) The stool from an ascending colon resection should be formed. (C) The healthy stoma should be red and slightly raised. If it begins to turn dark or blue, the client should see the physician immediately. (D) The stool in the ascending colon does not usually have many enzymes in it. Stool from an ileostomy has more enzymes and is more irritating to the skin.
NEW QUESTION # 388
Nursing care for the substance abuse client experiencing alcohol withdrawal delirium includes:
- A. Increasing sensory stimuli
- B. Applying ankle and wrist restraints
- C. Restricting fluid intake
- D. Maintaining seizure precautions
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) These clients are at high risk for seizures during the 1st week after cessation of alcohol intake. (B) Fluid intake should be increased to prevent dehydration. (C) Environmental stimuli should be decreased to prevent precipitation of seizures. (D) Application of restraints may cause the client to increase his or her physical activity and may eventually lead to exhaustion.
NEW QUESTION # 389
A 66-year-old female client has smoked 2 packs of cigarettes per day for 20 years. Her arterial blood gases on room air are as follows: pH 7.35; PO2 70 mm Hg; PCO2 55 mm Hg; HCO3 32 mEq/L. These blood gases reflect:
- A. Compensated metabolic acidosis
- B. Compensated respiratory alkalosis
- C. Compensated respiratory acidosis
- D. Uncompensated respiratory acidosis
Answer: C
Explanation:
(A) In compensated metabolic acidosis, the pH level is normal, the PCO2level is decreased, and the HCO3level is decreased. The client's primary alteration is an inability to remove excess acid via the kidneys. The lungs compensate by hyperventilating and decreasing PCO2. (B) In compensated respiratory acidosis, the pH level is normal, the PCO2level is elevated, and the HCO3level is elevated. The client's primary alteration is an inability to remove CO2from the lungs, so over time, the kidneys increase reabsorption of HCO3to buffer the CO2. (C) In compensated respiratory alkalosis, the pH level is normal, the PCO2level is decreased, and the HCO3level is decreased. The client's primary alteration is hyperventilation, which decreases PCO2. The client compensates by increasing the excretion of HCO3from the body. (D) In uncompensated respiratory acidosis, the pH level is decreased, the PCO2level is increased, and the HCO3level is normal. The client's primary alteration is an inability to remove CO2from the lungs. The kidneys have not compensated by increasing HCO3reabsorption.
NEW QUESTION # 390
A 48-year-old client presents with a long history of severedepression unrelieved by medication. He is admitted to the hospital for electroconvulsive therapy. Familymembers are very concerned about this therapy and are requesting information about aftereffects of the treatment. The nurse informs the family that he will:
- A. Require no special care after the procedure
- B. Have transient memory loss, confusion, andheadache
- C. Be alert and oriented immediately after the treatment
- D. Have insomnia for the first few days
Answer: B
Explanation:
(A) This answer is correct. The client will be confused and have a memory loss, which is usually temporary, after electroconvulsive shock therapy. (B) This answer is incorrect. The client will experience transient memory loss, look bewildered, and be confused initially. (C) This answer is incorrect. The client will sleep immediately following the treatment. (D) This answer is incorrect. Vital signs are taken at least hourly after treatment. The client is monitored for hypotension, tachycardia, respiratory problems, and possible seizure activity.
NEW QUESTION # 391
A client returns to the cardiovascular intensive care unit following his coronary artery bypass graft. In planning his care, the most important electrolyte the nurse needs to monitor will be:
- A. HCO3
- B. Potassium
- C. Chloride
- D. Sodium
Answer: B
Explanation:
(A) Chloride, HCO3, and sodium will need to be monitored, but monitoring these electrolytes is not as important as potassium monitoring. (B) Chloride, HCO3, and sodium will need to be monitored, but monitoring these electrolytes is not as important as potassium monitoring. (C) Potassium will need to be closely monitored because of its effects on the heart. Hypokalemia could result in supraventricular tachyarrhythmias. (D) Chloride, HCO3, and sodium will need to be monitored, but monitoring these electrolytes is not as important as potassium monitoring.
NEW QUESTION # 392
Provide the 1-minute Apgar score for an infant born with the following findings: Heart rate: Above 100 Respiratory effort: Slow, irregular Muscle tone: Some flexion of extremities Reflex irritability: Vigorous cry Color: Body pink, blue extremities
- A. 0
- B. 1
- C. 2
- D. 3
Answer: B
Explanation:
Explanation
(A) Seven out of a possible perfect score of 10 is correct. Two points are given for heart rate above 100; 1 point is given for slow, irregular respiratory effort; 1 point is given for some flex- ion of extremities in assessing muscle tone; 2 points are given for vigorous cry in assessing reflex irritability; 1 point is assessed for color when the body is pink with blue extremities (acrocyanosis). (B) For a perfect Apgar score of 10, the infant would have a heart rate over 100 but would also have a good cry, active motion, and be completely pink. (C) For an Apgar score of 8 the respiratory rate, muscle tone, or color would need to fall into the 2-point rather than the 1-point category. (D) For this infant to receive an Apgar score of 9, four of the areas evaluated would need ratings of 2 points and one area, a rating of 1 point.
NEW QUESTION # 393
A male client is experiencing auditory hallucinations. His nurse enters the room and he tells her that his mother is talking to him, and he will take his medicine after she leaves. The nurse looks around the room and sees that she and the client are the only ones in the room. The nurse's most therapeutic response will be:
- A. "Why don't you finish talking to her, and I'll wait."
- B. "She may be here, but I can't see her."
- C. "I don't see your mother in the room. Let's talk about how you're feeling."
- D. "OK, I'll come back later when you're feeling more like taking your medicine."
Answer: C
Explanation:
Section: Questions Set F
Explanation:
(A) This response uses the principle of reality orientation by the nurse telling the client that he or she does not see anything, but it does recognize his feelings. (B) This response does not make it clear that the nurse does not see anyone else in the room, and the nurse leaves the client alone to continue hallucinating. (C) This response leaves room for doubt; the nurse is further confusing the client by this statement. (D) This response reinforces the hallucination and implies that the nurse sees his mother, too.
NEW QUESTION # 394
A 50-year-old male client is to receive chemotherapy. The physician's orders include antiemetics. When planning his care, the nurse should take into consideration that antiemetics are best administered in the following way:
- A. Give antiemetics intermittently during the entire course of chemotherapy.
- B. Give antiemetics when nausea is experienced and continue on a regular schedule for 12-24 hours.
- C. Give antiemetics one at a time because combinations of antiemetics cause overwhelming side effects.
- D. Give antiemetics prior to the client receiving chemotherapy and continue on a regular basis for at least 24-48 hours after chemotherapy.
Answer: D
Explanation:
(A) Nausea is more difficult to control if antiemetics are withheld until nausea is experienced. (B) Antiemetics should be given prophylactically at the beginning of chemotherapy and continued on an around-the-clock basis to prevent nausea. (C) Combinations of antiemetics give the best control for nausea by blocking various causes of nausea induced by chemotherapy. (D) Antiemetics should be given around the clock during the course of chemotherapy. This prevents nausea from developing and prevents anticipatory nausea during subsequent chemotherapy administrations.
NEW QUESTION # 395
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