NCLEX Practice Exam 42 (10 Questions)

1. A two-year-old child has sustained an injury to the leg and refuses to walk. The nurse in the emergency department documents swelling of the lower affected leg. Which of the following does the nurse suspect is the cause of the child's symptoms?

Possible fracture of the tibia.

Bruising of the gastrocnemius muscle.

Possible fracture of the radius.

No anatomic injury. the child wants his mother to carry him.

The child’s refusal to walk. combined with swelling of the limb is suspicious for fracture. Toddlers will often continue to walk on a muscle that is bruised or strained. The radius is found in the lower arm and is not relevant to this question. Toddlers rarely feign injury to be carried. and swelling indicates a physical injury.

Explanation

The child’s refusal to walk. combined with swelling of the limb is suspicious for fracture. Toddlers will often continue to walk on a muscle that is bruised or strained. The radius is found in the lower arm and is not relevant to this question. Toddlers rarely feign injury to be carried. and swelling indicates a physical injury.

2. A patient is admitted to the hospital for routine elective surgery. Included in the list of current medications is Coumadin (warfarin) at a high dose. Concerned about the possible effects of the drug. particularly in a patient scheduled for surgery. the nurse anticipates which of the following actions?

Draw a blood sample for prothrombin (PT) and international normalized ratio (INR) level.

Administer vitamin K.

Draw a blood sample for type and crossmatch and request blood from the blood bank.

Cancel the surgery after the patient reports stopping the Coumadin one week previously.

The effect of Coumadin is to inhibit clotting. The next step is to check the PT and INR to determine the patient’s anticoagulation status and risk of bleeding. Vitamin K is an antidote to Coumadin and may be used in a patient who is at imminent risk of dangerous bleeding. Preparation for transfusion. as described in option C. is only indicated in the case of significant blood loss. If lab results indicate an anticoagulation level that would place the patient at risk of excessive bleeding. the surgeon may choose to delay surgery and discontinue the medication.

Explanation

The effect of Coumadin is to inhibit clotting. The next step is to check the PT and INR to determine the patient’s anticoagulation status and risk of bleeding. Vitamin K is an antidote to Coumadin and may be used in a patient who is at imminent risk of dangerous bleeding. Preparation for transfusion. as described in option C. is only indicated in the case of significant blood loss. If lab results indicate an anticoagulation level that would place the patient at risk of excessive bleeding. the surgeon may choose to delay surgery and discontinue the medication.

3. Emergency department triage is an important nursing function. A nurse working the evening shift is presented with four patients at the same time. Which of the following patients should be assigned the highest priority?

A patient with low-grade fever. headache. and myalgias for the past 72 hours.

A patient who is unable to bear weight on the left foot. with swelling and bruising following a running accident.

A patient with abdominal and chest pain following a large. spicy meal.

A child with a one-inch bleeding laceration on the chin but otherwise well after falling while jumping on his bed.

Emergency triage involves quick patient assessment to prioritize the need for further evaluation and care. Patients with trauma. chest pain. respiratory distress. or acute neurological changes are always classified number one priority. Though the patient with chest pain presented in the question recently ate a spicy meal and may be suffering from heartburn. he also may be having an acute myocardial infarction and require urgent attention. The patient with fever. headache and muscle aches (classic flu symptoms) should be classified as non-urgent. The patient with the foot injury may have sustained a sprain or fracture. and the limb should be x-rayed as soon as is practical. but the damage is unlikely to worsen if there is a delay. The child’s chin laceration may need to be sutured but is also non-urgent.

Explanation

Emergency triage involves quick patient assessment to prioritize the need for further evaluation and care. Patients with trauma. chest pain. respiratory distress. or acute neurological changes are always classified number one priority. Though the patient with chest pain presented in the question recently ate a spicy meal and may be suffering from heartburn. he also may be having an acute myocardial infarction and require urgent attention. The patient with fever. headache and muscle aches (classic flu symptoms) should be classified as non-urgent. The patient with the foot injury may have sustained a sprain or fracture. and the limb should be x-rayed as soon as is practical. but the damage is unlikely to worsen if there is a delay. The child’s chin laceration may need to be sutured but is also non-urgent.

4. A child is admitted to the hospital several days after stepping on a sharp object that punctured her athletic shoe and entered the flesh of her foot. The physician is concerned about osteomyelitis and has ordered parenteral antibiotics. Which of the following actions is done immediately before the antibiotic is started?

The admission orders are written.

A blood culture is drawn.

A complete blood count with differential is drawn.

The parents arrive.

Antibiotics must be started after the blood culture is drawn. as they may interfere with the identification of the causative organism. The blood count will reveal the presence of infection but does not help identify an organism or guide antibiotic treatment. Parental presence is important for the adjustment of the child but not for the administration of medication.

Explanation

Antibiotics must be started after the blood culture is drawn. as they may interfere with the identification of the causative organism. The blood count will reveal the presence of infection but does not help identify an organism or guide antibiotic treatment. Parental presence is important for the adjustment of the child but not for the administration of medication.

5. A nurse is assigned to the pediatric rheumatology clinic and is assessing a child who has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?

The child has a poor chance of recovery without joint deformity.

Most children progress to adult rheumatoid arthritis.

Nonsteroidal anti-inflammatory drugs are the first choice in treatment.

Physical activity should be minimized.

Nonsteroidal anti-inflammatory drugs are important first line treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Half of children with the disorder recover without joint deformity. and about a third will continue with symptoms into adulthood. Physical activity is an integral part of therapy.

Explanation

Nonsteroidal anti-inflammatory drugs are important first line treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Half of children with the disorder recover without joint deformity. and about a third will continue with symptoms into adulthood. Physical activity is an integral part of therapy.

6. A patient is admitted to the hospital with a calcium level of 6.0 mg/dL. Which of the following symptoms would you NOT expect to see in this patient?

Numbness in hands and feet.

Muscle cramping.

Hypoactive bowel sounds.

Positive Chvostek’s sign.

Normal serum calcium is 8.5 – 10 mg/dL. The patient is hypocalcemic. Increased gastric motility. resulting in hyperactive (not hypoactive) bowel sounds. abdominal cramping and diarrhea is an indication of hypocalcemia. Numbness in hands and feet and muscle cramps are also signs of hypocalcemia. Positive Chvostek’s sign refers to the sustained twitching of facial muscles following tapping in the area of the cheekbone and is a hallmark of hypocalcemia.

Explanation

Normal serum calcium is 8.5 – 10 mg/dL. The patient is hypocalcemic. Increased gastric motility. resulting in hyperactive (not hypoactive) bowel sounds. abdominal cramping and diarrhea is an indication of hypocalcemia. Numbness in hands and feet and muscle cramps are also signs of hypocalcemia. Positive Chvostek’s sign refers to the sustained twitching of facial muscles following tapping in the area of the cheekbone and is a hallmark of hypocalcemia.

7. A nurse cares for a patient who has a nasogastric tube attached to low suction because of a suspected bowel obstruction. Which of the following arterial blood gas results might be expected in this patient?

PH 7.52. PCO2 54 mmHg.

PH 7.42. PCO2 40 mmHg.

PH 7.25. PCO2 25 mmHg.

PH 7.38. PCO2 36 mmHg.

A patient on nasogastric suction is at risk of metabolic alkalosis as a result of loss of hydrochloric acid in gastric fluid. Of the answers given. only answer A (pH 7.52. PCO2 54 mm Hg) represents alkalosis. Answer B is a normal blood gas. Answer C represents respiratory acidosis. Answer D is borderline normal with slightly low PCO2.

Explanation

A patient on nasogastric suction is at risk of metabolic alkalosis as a result of loss of hydrochloric acid in gastric fluid. Of the answers given. only answer A (pH 7.52. PCO2 54 mm Hg) represents alkalosis. Answer B is a normal blood gas. Answer C represents respiratory acidosis. Answer D is borderline normal with slightly low PCO2.

8. A child has recently been diagnosed with Duchenne's muscular dystrophy. The parents are receiving genetic counseling prior to planning another pregnancy. Which of the following statements includes the most accurate information?

Duchenne’s is an X-linked recessive disorder. so both daughters and sons have a 50% chance of developing the disease.

Each child has a 1 in 4 (25%) chance of developing the disorder.

Sons only have a 1 in 4 (25%) chance of developing the disorder.

The recessive Duchenne gene is located on one of the two X chromosomes of a female carrier. If her son receives the X bearing the gene he will be affected. Thus. there is a 50% chance of a son being affected. Daughters are not affected. but 50% are carriers because they inherit one copy of the defective gene from the mother. The other X chromosome comes from the father. who cannot be a carrier.

Explanation

The recessive Duchenne gene is located on one of the two X chromosomes of a female carrier. If her son receives the X bearing the gene he will be affected. Thus. there is a 50% chance of a son being affected. Daughters are not affected. but 50% are carriers because they inherit one copy of the defective gene from the mother. The other X chromosome comes from the father. who cannot be a carrier.

9. The follow lab results are received for a patient. Which of the following results are abnormal? Note: More than one answer may be correct.

Hemoglobin 10.4 g/dL.

Total cholesterol 340 mg/dL.

Total serum protein 7.0 g/dL.

Glycosylated hemoglobin A1C 5.4%.

Normal hemoglobin in adults is 12 – 16 g/dL. Total cholesterol levels of 200 mg/dL or below are considered normal. Total serum protein of 7.0-g/dL and glycosylated hemoglobin A1c of 5.4% are both normal levels.

Explanation

Normal hemoglobin in adults is 12 – 16 g/dL. Total cholesterol levels of 200 mg/dL or below are considered normal. Total serum protein of 7.0-g/dL and glycosylated hemoglobin A1c of 5.4% are both normal levels.

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10. A toddler has recently been diagnosed with cerebral palsy. Which of the following information should the nurse provide to the parents? Note: More than one answer may be correct.

Regular developmental screening is important to avoid secondary developmental delays.

Developmental milestones may be slightly delayed but usually will require no additional intervention.

Parent support groups are helpful for sharing strategies and managing health care issues.

Delayed developmental milestones are characteristic of cerebral palsy. so regular screening and intervention is essential. Because of injury to upper motor neurons. children may have ocular and speech difficulties. Parent support groups help families to share and cope. Physical therapy and other interventions can minimize the extent of the delay in developmental milestones.

Explanation

Delayed developmental milestones are characteristic of cerebral palsy. so regular screening and intervention is essential. Because of injury to upper motor neurons. children may have ocular and speech difficulties. Parent support groups help families to share and cope. Physical therapy and other interventions can minimize the extent of the delay in developmental milestones.

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