Nclex-rn Exam Free Review By Nclex Masters

265 Questions  I  By Rneducator
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1.  The nurse is working in a high risk antepartal clinic. A 40 year-old woman in the first trimester gives a thorough health history. Which of the following collected data should receive priority attention by the nurse?
A.
B.
C.
D.
2.  When planning for the care of a client with a pressure ulcer on the sacrum, the nurse would include which of the following?
A.
B.
C.
D.
3.  X-RN A client with a diagnosis of methicillin resistant staphylococcus aureus (MRSA) has died. Which type of transmission-based precautions is the appropriate type to use when performing postmortem care?
A.
B.
C.
D.
4.  The hospice nurse is visiting a 75 year-old client with end-stage cancer. For chronic malignant pain management in this client the nurse understands that:
A.
B.
C.
D.
5.  The nurse should be informed about cultural issues related to the client's background because one of the following:
A.
B.
C.
D.
6.  In addition to handwashing, an appropriate infection control intervention during the care of a newly admitted adult client with a diagnosis of Hepatitis A would be which action?
A.
B.
C.
D.
7.  Postoperative nursing care for an infant who has had a pyloromyotomy would include which of these items?
A.
B.
C.
D.
8.  The parents of a four year-old hospitalized child tell the nurse they will leave for a time and return at 6 PM. When the child asks when the parents will come again, the nurse can best respond by saying:
A.
B.
C.
D.
9.  A client calls the PN because of an onset of chest pain. Which of these statements would require the most immediate action?
A.
B.
C.
D.
10.  The nurse realizes that the discharge instructions given to a woman with placenta previa are understood when the nurse overhears the client tell her husband,
A.
B.
C.
D.
11.  A client was just taken off the ventilator following surgery and has a nasogastric tube draining bile colored liquids. Which nursing measure will provide the most comfort to the client?
A.
B.
C.
D.
12.  A ten year-old child has a history of tonic-clonic seizures. The school nurse should instruct the classroom teacher that if the child experiences a seizure in the classroom, the most important action during the seizure activity would be to
A.
B.
C.
D.
13.  The nurse is assessing a six-month-old infant during a well child visit. The nurse makes all of the following observations. Which of the following assessments made by the nurse is an area of concern indicating a need for further evaluation?
A.
B.
C.
D.
14.  If a nurse is uncertain about whether he or she is licensed to perform certain tasks, they should first check information in which of these resources?
A.
B.
C.
D.
15.  What is the primary nursing intervention to limit transmission of organisms for a client with a salmonella infection?
A.
B.
C.
D.
16.  The mother of an infant who is being treated for pesticide poisoning asks why activated charcoal is the treatment. What is the nurse's best response?
A.
B.
C.
D.
17.  A nurse observes a family member administer a rectal suppository by having the client lie on the left side for the administration. The family member pushed the suppository until the finger went up to the second knuckle. After 10 minutes the client was told by the family member to turn to the right side and the client did this. What is the appropriate comment for the nurse to make?
A.
B.
C.
D.
18.  Mr. A. has sprained his ankle. The physician would order cold applied to the injured area to
A.
B.
C.
D.
19.  In taking the history of a pregnant woman, which factor would the nurse recognize as the primary contraindication for breast feeding?
A.
B.
C.
D.
20.  Which of the following is least likely to influence the potential for patient to comply with lithium therapy after discharge?
A.
B.
C.
D.
21.  A three year-old child is treated in the emergency room after ingestion of an ounce from a liquid narcotic bottle. What action should the nurse take first?
A.
B.
C.
D.
22.  A client is receiving a nitroglycerin (NTG) infusion for unstable angina. What would be a priority for monitoring the effects of this medication?
A.
B.
C.
D.
23.  The nurse is checking a woman in early labor. While positioning for a vaginal exam, she complains of dizziness and nausea and appears pale. Her blood pressure has dropped slightly. What is the appropriate initial nursing action?
A.
B.
C.
D.
24.  A client says, "It's raining outside and it's raining in my heart. Did you know that St. Patrick drove the snakes out of Ireland? I've never been to Ireland." The nurse reviews this data and determines that this client is experiencing a speech pattern commonly seen in manic episodes called
A.
B.
C.
D.
25.  A nurse is to collect a sputum specimen for acid-fast bacillus (AFB) from a client. Which action should the nurse take first?
A.
B.
C.
D.
26.  9.    Miss Rodriguez is an 88-year-old client at a long-term care facility. Prior to administering any medication or treatment to this client the nurse must confirm identity by asking the client if she is Miss Rodriguez
A.
B.
C.
D.
27.  A child, injured on the school playground, appears to have a fractured leg. The first action the school nurse should take is
A.
B.
C.
D.
28.  Following change-of-shift report on an orthopedic unit, which client should the nurse see first?
A.
B.
C.
D.
29.  The parents of a child who has suddenly been hospitalized for an acute illness state that they should have taken the child to the pediatrician earlier. Which approach by the nurse is appropriate?
A.
B.
C.
D.
30.  A client tells the nurse, "I have something very important to tell you if you promise not to tell anyone." The appropriate response by the nurse would be
A.
B.
C.
D.
31.  The physician's orders for Mr. C. include warm compresses to the left leg three times a day for treatment of an open wound. The nurse should
A.
B.
C.
D.
32.  The nurse is reinforcing teaching to a 24 year-old woman receiving acyclovir (Zovirax) for a Herpes Simplex Virus type 2 infection. The nurse should be sure to include which information?
A.
B.
C.
D.
33.  A child is admitted to the pediatric unit with a diagnosis of suspected meningococcal meningitis. Which of these nursing actions should the nurse expect to do first?
A.
B.
C.
D.
34.  The nurse is caring for a four year-old two hours after tonsillectomy and adenoidectomy. Which observation must be reported immediately?
A.
B.
C.
D.
35.  A 14 month-old child ingested half a bottle of aspirin tablets. Which finding would the nurse expect to see in the child?
A.
B.
C.
D.
36.  19.    The nurse is caring for a 48-hour full-term infant whose mother abused cocaine and heroin throughout pregnancy. The mother does not wish to go into rehabilitation at this time. The nursing care plan should include which of the following?            
A.
B.
C.
D.
37.  A client is admitted with severe injuries from an auto accident. The client's vital signs are BP 120/50, pulse rate 110, and respiratory rate of 28. The initial nursing intervention would be to
A.
B.
C.
D.
38.  A nurse arranges for an interpreter to assist with communication between the health care team and a non-English speaking client. To promote therapeutic communication when working with an interpreter, the utmost thing for the nurse to remember is to :
A.
B.
C.
D.
39.  The nurse is caring for a two month-old infant with a congenital heart defect. Which of the following is a priority nursing action?
A.
B.
C.
D.
40.  For which procedure would the nurse use aseptic technique and which would require the nurse to use sterile technique?
A.
B.
C.
D.
41.  A 14 month-old child ingested half a bottle of aspirin tablets. Which finding would the nurse expect to see in the child?
A.
B.
C.
D.
42.  A client with paranoid delusions stares at the nurse over a period of several days. The client suddenly walks up to the nurse and shouts "You think you're so perfect and pure and good." The appropriate response for the nurse is:  
A.
B.
C.
D.
43.  Which nursing diagnosis would indicate that an 86 year-old client is at greatest risk for falls?
A.
B.
C.
D.
44.  The nurse is assisting in the assessment of a client's home in preparation for discharge. Which focus should be given priority consideration?
A.
B.
C.
D.
45.  A 64 year-old client scheduled for surgery with a general anesthetic refuses to remove her dentures prior to leaving the unit for the operating room. The most appropriate intervention by the nurse is:
A.
B.
C.
D.
46.  A nurse arranges for an interpreter to assist with communication between the health care team and a non-English speaking client. To promote therapeutic communication when working with an interpreter, the utmost thing for the nurse to remember is to :
A.
B.
C.
D.
47.  A client receiving chlorpromazine HCL (Thorazine) is in psychiatric home care. During a home visit the nurse observes the client smacking the lips alternately with grinding of the teeth. The nurse assesses this as
A.
B.
C.
D.
48.  The mother of a three-month-old infant asks the nurse when she can start feeding her baby solid food. Which of the following should the nurse include in teaching this mother about the nutritional needs of infants?
A.
B.
C.
D.
49.  When a client is diagnosed with tuberculosis, the public health department is to be notified for what reason?
A.
B.
C.
D.
50.   The nurse is talking with a mother to assess her child. A positive response to which question would indicate the child is in the anal stage of psychosexual development as described by Freud?
A.
B.
C.
D.
51.  The nurse is collecting data on a client with a stage 2 skin ulcer. Which treatment is considered most effective to promote healing?
A.
B.
C.
D.
52.  The hospice nurse is visiting a 75 year-old client with end-stage cancer. For chronic malignant pain management in this client the nurse understands that:
A.
B.
C.
D.
53.  A client refuses to take the medication prescribed because the client prefers to take an herbal preparation. What is the first action the nurse should take?
A.
B.
C.
D.
54.  The nurse is reinforcing teaching about the use of nonsteroidal anti-inflammatory (NSAIDs) drugs to a group of arthritic clients. To minimize the side effects, the nurse should emphasize
A.
B.
C.
D.
55.  The nurse recognizes that the client with posttraumatic stress disorder (PTSD), is improving when he
A.
B.
C.
D.
56.  Which of these actions best describes the application of time management strategies for the role of the PN charge nurse?
A.
B.
C.
D.
57.  Which of these points should be reinforced during the discharge instructions to a client who is prescribed warfarin sodium (Coumadin) for the next six months?
A.
B.
C.
D.
58.  Which of these protocols would be essential for the nurse to implement during the care of a client with active tuberculosis?
A.
B.
C.
D.
59.  Which statement by the nurse is appropriate when asking an unlicensed assistive personnel (UAP) to assist a 69 year-old surgical client to ambulate for the first time?
A.
B.
C.
D.
60.  The mother of a two year-old hospitalized child asks the nurse's advice about the child's screaming every time the mother gets ready to leave the hospital room. The best response of the nurse would be to:    
A.
B.
C.
D.
61.  Which nursing diagnosis would indicate that an 86 year-old client is at greatest risk for falls?
A.
B.
C.
D.
62.  The nurse is caring for a post-operative client who develops an abdominal wound evisceration. The first nursing intervention should be to
A.
B.
C.
D.
63.  The nurse is caring for a client who is receiving TPA (altipase) For a cerebral vascular accident (CVA). Which of these nursing interventions should receive priority?
A.
B.
C.
D.
64.  The health care provider order reads "aspirate nasogastric feeding (NG) tube every four hours and check pH of aspirate". The pH of the aspirate is 10. Which action should the nurse take?
A.
B.
C.
D.
65.  Mr. D. has a disorder of the hypothalamus and is on a hypothermia blanket. The nurse should make which of the following assessments?
A.
B.
C.
D.
66.  A client has been taking Procardia for Raynaud's disease and hypertension. Which finding would indicate that the client may be having a side effect of the medication?
A.
B.
C.
D.
67.  A 5 years old child has been admitted to the pediatric unit after swallowing a household cleaner. Which of these findings is more commonly associated with the fact that the poison was a corrosive?
A.
B.
C.
D.
68.  The mother of an infant who is being treated for pesticide poisoning asks why activated charcoal is the treatment. What is the nurse's best response?
A.
B.
C.
D.
69.  X-RN A client with a diagnosis of methicillin resistant staphylococcus aureus (MRSA) has died. Which type of transmission-based precautions is the appropriate type to use when performing postmortem care?
A.
B.
C.
D.
70.  The nurse is assisting with a pre-kindergarten physical on a five year-old. The last MMR vaccine will be administered. Allergy to which item might be a contraindication to giving the vaccine?
A.
B.
C.
D.
71.  The nurse uses a wide stance when moving a heavy box of supplies. Which of the following is the best reason the nurse would do this? Because it
A.
B.
C.
D.
72.  While caring for a client, the nurse notes a pulsating mass in the client's periumbilical area. Which of the following actions is appropriate for the nurse to perform?
A.
B.
C.
D.
73.  The best action to establish correct placement of a gastric tube is for the nurse to
A.
B.
C.
D.
74.  A client with heart failure has been instructed by the RN about proper nutrition. The selection of which lunch indicates the client has learned about sodium restriction?
A.
B.
C.
D.
1 comment
75.  Mr. T. is a C4 quadriplegic in a nursing home. Which of the following techniques would the nurse use to transfer him from bed to wheelchair?
A.
B.
C.
D.
76.  Which newly admitted client would be most appropriate to assign to the unlicensed assistive personnel (UAP)?
A.
B.
C.
D.
77.  Ms. F. suffered a stroke and has right-sided hemiparesis. The nurse is going to transfer her from bed to wheelchair. Which of the following is the best method?
A.
B.
C.
D.
78.  Marty Cole, 7 years old, is admitted to the pediatric service with a diagnosis of juvenile diabetes mellitus. He has not been under treatment previously. When counseling Marty about his diabetes and its treatment, you would advise against eating
A.
B.
C.
D.
79.  The nurse in the delivery room is caringfor the newborn. Which action is the most important and most immediate action for the nurse to take?
A.
B.
C.
D.
80.  Marty Cole, 7 years old, is admitted to the pediatric service with a diagnosis of juvenile diabetes mellitus. He has not been under treatment previously. As a practical nurse, you would expect Marty to exhibit all of the following symptoms EXCEPT
A.
B.
C.
D.
81.  The nurse is caring for a client who is receiving procainamide (Pronestyl) intravenously. What is a priority for the nurse to do for her client?
A.
B.
C.
D.
82.  Mr. Reynolds, 69 years of age, is found unconscious by his wife at 7:00 a.m. An ambulance is summoned by the physician, and Mr. Reynolds is admitted to the medical unit, where you work as a practical nurse, with a diagnosis of cerebral vascular accident (CVA). As you assist the team leader with the admission process, you note a previous history of hypertension. His wife has also revealed that Mr. Reynolds complained of a headache before retiring the night before. The team leader instructs you to remove Mr. Reynolds's dentures. You do so because
A.
B.
C.
D.
83.  A client receives high doses of potassium over 30 minutes. Which is a priority to check prior to giving this medication?
A.
B.
C.
D.
84.  After working with a very demanding client, an unlicensed assistive personnel (UAP) tells the nurse, "I have had it with that client. I just can't do anything that pleases him. I'm not going in there again." The nurse's appropriate response should be
A.
B.
C.
D.
85.  A client with a diagnosis of bipolar disorder has been referred to a local boarding home to be considered for placement. The social worker telephoned the hospital unit for information about the client's mental status and adjustment. The nurse should know that the most acceptable is : 
A.
B.
C.
D.
86.  Mr. Reynolds, 69 years of age, is found unconscious by his wife at 7:00 a.m. An ambulance is summoned by the physician, and Mr. Reynolds is admitted to the medical unit, where you work as a practical nurse, with a diagnosis of cerebral vascular accident (CVA). As you assist the team leader with the admission process, you note a previous history of hypertension. His wife has also revealed that Mr. Reynolds complained of a headache before retiring the night before. In addition to the headache and hypertension, which of the following symptoms would you expect Mr. Reynolds to exhibit?
A.
B.
C.
D.
87.  Ms. L. is to go home with her family. The nurse is evaluating that the family members can correctly move Ms. L. from the bed to a chair. Which of the following should be seen?
A.
B.
C.
D.
88.  Scoliosis a C S curvature of the spine; it cna a temporary or permanent condidtion. At what time would the nurse expect early findings of scoliosis to appear?                                                                                      
A.
B.
C.
D.
89.  The community health nurse is making a newborn follow-up home visit. During the visit the two-year-old sibling has a temper tantrum. The parent asks the nurse for guidance in dealing with the toddler's temper tantrums. Which of the following is the most appropriate nursing action?
A.
B.
C.
D.
90.  A client is admitted to the emergency room following an acute asthma attack. Which of the following findings would be most important to report?
A.
B.
C.
D.
91.  Which of these actions best describes the application of time management strategies for the role of the PN charge nurse?
A.
B.
C.
D.
92.  A client is recovering from a hip replacement and is taking Tylenol #3 every 3 hours for pain. In checking the client, which finding suggests a side effect of the analgesic?
A.
B.
C.
D.
93.  Which cognitive skill would the nurse expect a six-year-old child to be in the process of developing?
A.
B.
C.
D.
94.  The nurse is assisting with teaching a group of college students about breast self-examination. A woman asks when to perform the monthly exam. The appropriate reply by the nurse would be which of these?
A.
B.
C.
D.
95.  Which one of these tasks could be assigned to the certified nursing assistant (cna)? 
A.
B.
C.
D.
96.  Ms. O'Brien is bedridden. The nurse is evaluating whether the family members understand how to position the client correctly. Which of the following should the nurse observe?
A.
B.
C.
D.
1 comment
97.  Mr. S. is to have a tepid sponge bath to lower his fever. What temperature should the nurse make the water?
A.
B.
C.
D.
98.  A client frequently compliments the nurse and invites the nurse to go to a movie and dinner. The nurse should take which approach?
A.
B.
C.
D.
99.  A client states, "People think I'm no good, you know what I mean?" Which nursing response would be most therapeutic for this client?
A.
B.
C.
D.
100.  A 14 years child goes into seizures. Which nursing action is a priority for a client during a seizure
A.
B.
C.
D.
101.  A young adult is involuntarily admitted to the psychiatric unit in a manic state. Upon arrival on the unit he is unable to sit, and it is very difficult to follow what he is saying because of the rate and content of speech. He is very provocative and refuses to eat or drink. The area of disturbance that poses the greatest physical danger to this client is
A.
B.
C.
D.
102.  Privacy and confidentiality of client information is legally protected. In which of these situations would the nurse make an exception to this practice?
A.
B.
C.
D.
103.  Several clients are admitted to an adult medical unit. The nurse would expect airborne precautions for a client with which of the following medical conditions?
A.
B.
C.
D.
104.  The nurse is caring for a 30-week baby girl who is currently receiving 15 ml of breast milk via oral gastric tube every three hours. As part of the routine assessment the nurse should assess which of the following?
A.
B.
C.
D.
105.  Mrs. F. has remained close to the nurse all day. When the nurse talked with other clients during dinner, Mrs. F. tried to regain the nurse's attention and then began to shout "You're just like my mother. You pay attention to everyone but me!" The best interpretation of this behavior is that
A.
B.
C.
D.
106.  The nurse is reinforcing instructions for a client with asthma. Which item should be stressed for the client to monitor on a daily basis?
A.
B.
C.
D.
107.  A female client is admitted for a breast biopsy. She says, tearfully to the nurse, "If this turns out to be cancer and I have to have my breast removed, my companion will never come near me." The nurse's best response would be "Are you:
A.
B.
C.
D.
108.  Which of the followwing entries in the progress notes of a client is the most complete?
A.
B.
C.
D.
109.  Which action would be the best strategy for the nurse to use when reinforcing insulin injection techniques to a newly diagnosed adult client with diabetes mellitus?
A.
B.
C.
D.
110.  Mr. Warren, a client with paranoid schizophrenia, has a delusion of persecution. He tells the nurse, "They are out to get me. They're spying on me." The nurse's best initial response is :
A.
B.
C.
D.
111.  While giving nursing care to a hospitalized adolescent, the nurse should be aware that the major threat felt by the hospitalized adolescent is :
A.
B.
C.
D.
112.  The nurse will administer liquid medicine to a nine month-old child. Which method is appropriate?
A.
B.
C.
D.
113.  A client refuses to take the medication prescribed because the client prefers to take an herbal preparation. What is the first action the nurse should take?
A.
B.
C.
D.
114.  The partner of a client with Alzheimer's disease expresses concern about the burden of caregiving. Which action by the nurse should be a priority?
A.
B.
C.
D.
115.  A child is admitted to the pediatric unit with a diagnosis of suspected meningococcal meningitis. Which of these nursing actions should the nurse expect to do first?
A.
B.
C.
D.
116.  Mr. C. has just been admitted for acute asthma exacerbation and placed in a high Fowler's position. The nurse knows this position is best because it
A.
B.
C.
D.
117.  The nurse is responsible for assisting in the decisions about client room assignments. Which of these possible roommates would be most appropriate for a three year-old child with minimal change nephrotic syndrome?
A.
B.
C.
D.
118.  An adult is admitted to the hospital to undergo a stapedectomy for the treatment of otosclerosis. Which findings elicited during physical assessment are most indicative of otosclerosis?
A.
B.
C.
D.
119.  A female client is admitted for a breast biopsy. She says, tearfully to the nurse, "If this turns out to be cancer and I have to have my breast removed, my companion will never come near me." The nurse's best response would be "Are you:
A.
B.
C.
D.
120.  A client with chronic obstructive pulmonary disease (COPD) and a history of coronary artery disease is receiving Aminophylline, 25mg/hour. Which finding by the nurse would require immediate intervention?
A.
B.
C.
D.
121.  While giving nursing care to a hospitalized adolescent, the nurse should be aware that the major threat felt by the hospitalized adolescent is :
A.
B.
C.
D.
122.  An outpatient client is scheduled to receive an oral solution of radioactive iodine. In order to reduce hazards, the nurse should reinforce to the client that
A.
B.
C.
D.
123.  Ms. P. is transferred to a skilled nursing facility from the hospital because she is unable to ambulate due to a left femoral fracture. The nurse knows Ms. P.'s greatest risk factor for developing a pressure ulcer is that she
A.
B.
C.
D.
124.  A nurse is part of a community task force on teenage suicide. The task force is considering all of the following steps in an effort to reduce teen suicide. Which action represents primary prevention?
A.
B.
C.
D.
125.  The nurse is caring for a client several days following a cerebral vascular accident (CVA). Coumadin (warfarin) has been prescribed. Today's prothrombin level is abnormally elevated. Which item is a priority to check?
A.
B.
C.
D.
126.  In the last 48 hours of life, a hospice client may complain of dry mouth from a poor fluid intake. The nurse should only offer to moisten the mouth because:
A.
B.
C.
D.
127.  The nurse observes a newborn whose Apgar score was 8 and 9. This score would be most closely associated with which of these areas?
A.
B.
C.
D.
128.  The nurse monitors a client after the treatment of bradycardia with intravenous atropine sulfate. Which of these findings should be reported to the health care provider immediately?
A.
B.
C.
D.
129.  An important goal in the development of a therapeutic inpatient milieu is providing a A) businesslike atmosphere where clients can work on individual goals forum in which clients deB) group cide on unit rules, regulations, and policies
A.
B.
C.
D.
130.  A client who has just joined a health maintenance organization (HMO) asks for information about the payment obligations with this plan. The most accurate description of health care costs is that the client will be charged
A.
B.
C.
D.
131.  The nurse would reinforce the need to take alendronate (Fosamax) as prescribed by the physician,
A.
B.
C.
D.
132.  In the last 48 hours of life, a hospice client may complain of dry mouth from a poor fluid intake. The nurse should only offer to moisten the mouth because:
A.
B.
C.
D.
133.  The health care provider order reads "aspirate nasogastric feeding (NG) tube every four hours and check pH of aspirate". The pH of the aspirate is 10. Which action should the nurse take?
A.
B.
C.
D.
134.  A client receiving chlorpromazine HCL (Thorazine) is in psychiatric home care. During a home visit the nurse observes the client smacking the lips alternately with grinding of the teeth. The nurse assesses this as
A.
B.
C.
D.
135.  The nurse would anticipate that an eight month-old would be able to  do one or more of the following:
A.
B.
C.
D.
136.  The client is receiving an intravenous piggyback infusion of penicillin. Which client statement would require the nurse's immediate attention?
A.
B.
C.
D.
137.  The nurse is caring for a four year-old two hours after tonsillectomy and adenoidectomy. Which observation must be reported immediately?
A.
B.
C.
D.
138.  A client who has just joined a health maintenance organization (HMO) asks for information about the payment obligations with this plan. The most accurate description of health care costs is that the client will be charged
A.
B.
C.
D.
139.  After a client has an intestinal feeding tube inserted, the most accurate method for verification of placement is
A.
B.
C.
D.
140.  An outpatient client is scheduled to receive an oral solution of radioactive iodine. In order to reduce hazards, the nurse should reinforce to the client that
A.
B.
C.
D.
141.  A 64 year-old client scheduled for surgery with a general anesthetic refuses to remove her dentures prior to leaving the unit for the operating room. The most appropriate intervention by the nurse is:
A.
B.
C.
D.
142.  When a client is diagnosed with tuberculosis, the public health department is to be notified for what reason?
A.
B.
C.
D.