NCLEX RN Comprehensive Quiz

1.

Which of the following clients is at highest risk for colorectal cancer?

A.

The client who smokes.
B.

The client who has been treated for Crohn’s disease for 20 years.
C.

The client who has a family history of lung cancer.
D.

The client who eats a vegetarian diet

Correct Answer
C. The client who has a family history of lung cancer.

Explanation
Clients over age 50 who have a history of inflammatory bowel disease are at risk for colon cancer. The client who smokes is at high risk for lung cancer. While the exact cause is not always known, other risk factors for colon cancer are a diet high in animal fats, including a large amount of red meat and fatty foods with low fiber, and the presence of colon cancer in a first-generation relative.

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2.

The nurse monitors the serum electrolyte levels of a client who is taking digoxin (Lanoxin). Which of the following electrolyte imbalances is common cause of digoxin toxicity?

A.

Hypocalcemia.
B.

Hyponatremia.
C.

Hypomagnesemia.
D.

Hypokalemia.

Correct Answer
D. Hypokalemia.

Explanation
Hypokalemia is one of the most common causes of digoxin (Lanoxin) toxicity. It is essential that the nurse carefully monitor the potassium levels of the clients taking digoxin to avoid toxicity. Low serum potassium levels can cause cardiac dysrhythmias.

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3.

An 18-year-old client who recently had an upper respiratory infection is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis?

A.

Erythema marginatum, subcutaneous nodules, and fever
B.

Dyspnea, fatigue, and syncope
C.

Tachycardia, finger clubbing, and a loud second heart sound (S2)
D.

Dyspnea, cough, and palpitations

Correct Answer
A. Erythema marginatum, subcutaneous nodules, and fever

Explanation
Diagnosis of rheumatic fever requires that the client have either two major Jones criteria or one minor criterion plus evidence of a previous streptococcal infection. Major criteria include carditis, polyarthritis, Sydenham’s chorea, subcutaneous nodules, and erythema marginatum (transient, nonpruritic macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria include fever, arthralgia, elevated levels of acute phase reactants, and a prolonged PR interval on electrocardiography. Tachycardia, finger clubbing, and a loud S2 suggest transposition of the great arteries (a cyanotic congenital heart defect). Dyspnea, cough, and palpitations occur with mitral insufficiency. Dyspnea, fatigue, and syncope indicate aortic insufficiency.

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4.

A client has a reduced serum high-density lipoprotein (HDL) level and an elevated low-density lipoprotein (LDL) level. Which dietary modification is appropriate for this client?

A.

Fiber intake of less than 10% of total calories daily
B.

Less than 7% of calories from saturated fat
C.

Cholesterol intake of less than 300 mg daily
D.

Less than 40% of calories from fat

Correct Answer
B. Less than 7% of calories from saturated fat

Explanation
A client with low serum HDL and high serum LDL levels should get less than 7% of daily calories from saturated fat. Fiber intake should be at least 15% of total daily calories, total fat intake should be only 25% to 35% of daily calories, and cholesterol intake should be less than 200 mg daily.

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5.

Assessment of a nulligravid client in active labor reveals the following: complaints of moderate discomfort; cervix dilated 3 cm, 0 station and completely effaced; fetal heart rate of 136 bpm. Which of the following should the nurse plan to do next?

A.

Prepare the client for epidural anesthesia to relieve pain.
B.

Turn the client from the left side-lying position to the right side-lying position.
C.

Instruct the client that internal fetal monitoring is necessary.
D.

Assist the client with comfort measures and breathing techniques.

Correct Answer
D. Assist the client with comfort measures and breathing techniques.

Explanation
The client’s assessment findings indicate that the client is in the latent phase of the first stage of labor. Therefore, the nurse should plan to assist the client with comfort measures and breathing techniques to relieve discomfort. The client can move around, walk, or ambulate at this phase of labor. If the client chooses to remain in bed, a left side-lying position provides the greatest perfusion. It is too early for the client to have an epidural anesthetic. Epidural anesthesia is usually administered when the cervix is dilated 4 to 5 cm. the fetal heart rate is normal, so internal fetal monitoring is not warranted at this time.

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6.

A client who is complaining of back and left flank pain is diagnosed with renal calculi. The client is experiencing periods of complete comfort alternating with periods of excruciating pain, accompanied by nausea and difficulty walking. Based on these data, what is the priority nursing diagnosis for this client?

A.

Activity intolerance.
B.

Deficient fluid volume.
C.

Imbalanced nutrition: Less than body requirements.
D.

Acute pain.

Correct Answer
D. Acute pain.

Explanation
Pain is a priority for the client with renal calculi. The pain is typically described as excruciating and intermittent, occurring as the tone moves. Analgesics are a major part of therapy. Activity intolerance is secondary to excruciating pain. Although the client experiences occasional nausea, there are no data to support a nursing diagnosis of Deficient fluid volume or Imbalanced nutrition: Less than body requirements.

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7.

A potential concern when caring for an older adult who has diminished hearing and vision would be the client’s:

A.

Cognitive impairment.
B.

Feelings of disorientation.
C.

Sensory overload.
D.

Social isolation.

Correct Answer
D. Social isolation.

Explanation
Social isolation is a concern for an older adult who has diminished hearing and vision. Feeling disoriented may be related to cognitive problems rather than diminished hearing and vision.

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8.

On entering toddler’s room, the nurse finds the mother sitting about 8 feet from the child and watching television when the toddler is screaming. Which of the following is the most appropriate response by the nurse?

A.

Did something cause your child to be upset?
B.

Have you tried to calm down your child?
C.

Why is your child screaming?
D.

What happened between you and your child?

Correct Answer
C. Why is your child screaming?

Explanation
The toddler is screaming for a reason, so it is mist therapeutic to ask the mother why the child is screaming. This type of question is nonaccusatory, just seeking information. Asking the mother what happened between her and the child makes the assumption that something did happened limits the amount of information to be gained from the question. Asking whether something caused the child to be upset makes an assumption that something happened and limits the answer to a yes or no response, cutting off communication. Asking whether the mother has tried to calm a child is accusatory and also limits the response to a yes or no, thus cutting off communication.

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9.

A nurse is teaching a 50-year-old client how to decrease risk factors for coronary artery disease. He’s an executive who smokes, has a type A personality, and is hypertensive. Which risk factor is nonmodifiable?

A.

Age
B.

Smoking
C.

Personality
D.

Hypertension

Correct Answer
A. Age

Explanation
Age is a risk factor that is nonmodifiable. Type A personality, hypertension, and smoking factors can be controlled.

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10.

A nurse asks a nursing assistant to help admit an elderly client diagnosed with pneumonia. Which activity is appropriate for the nurse to ask the assistant to perform?

A.

Assess lung sounds.
B.

Insert a small-bore feeding tube.
C.

Obtain an arterial blood gas sample.
D.

Obtain the client’s height and weight.

Correct Answer
D. Obtain the client’s height and weight.

Explanation
Obtaining the client’s height and weight are appropriate actions for the nursing assistant to perform. The other options are the responsibility of the registered nurse or other licensed person.

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