NCLEX Practice Exam 45 (10 Questions)

1. A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission?

Sexual contact with an infected partner.

Contaminated food.

Blood transfusion.

Illegal drug use.

Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B. C. and D are transmitted through infected bodily fluids.

Explanation

Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B. C. and D are transmitted through infected bodily fluids.

2. A leukemia patient has a relative who wants to donate blood for transfusion. Which of the following donor medical conditions would prevent this?

A history of hepatitis C five years previously.

Cholecystitis requiring cholecystectomy one year previously.

Asymptomatic diverticulosis.

Crohn’s disease in remission.

Hepatitis C is a viral infection transmitted through bodily fluids. such as blood. causing inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to the high risk of infection in the recipient. Cholecystitis (gallbladder disease). diverticulosis. and history of Crohn’s disease do not preclude blood donation.

Explanation

Hepatitis C is a viral infection transmitted through bodily fluids. such as blood. causing inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to the high risk of infection in the recipient. Cholecystitis (gallbladder disease). diverticulosis. and history of Crohn’s disease do not preclude blood donation.

3. A nurse is caring for a patient with peripheral vascular disease (PVD). The patient complains of burning and tingling of the hands and feet and cannot tolerate touch of any kind. Which of the following is the most likely explanation for these symptoms?

Inadequate tissue perfusion leading to nerve damage.

Fluid overload leading to compression of nerve tissue.

Sensation distortion due to psychiatric disturbance.

Inflammation of the skin on the hands and feet.

Patients with peripheral vascular disease often sustain nerve damage as a result of inadequate tissue perfusion. Fluid overload is not characteristic of PVD. There is nothing to indicate psychiatric disturbance in the patient. Skin changes in PVD are secondary to decreased tissue perfusion rather than primary inflammation.

Explanation

Patients with peripheral vascular disease often sustain nerve damage as a result of inadequate tissue perfusion. Fluid overload is not characteristic of PVD. There is nothing to indicate psychiatric disturbance in the patient. Skin changes in PVD are secondary to decreased tissue perfusion rather than primary inflammation.

4. The nurse is conducting nutrition counseling for a patient with cholecystitis. Which of the following information is important to communicate?

The patient must maintain a low calorie diet.

The patient must maintain a high protein/low carbohydrate diet.

The patient should limit sweets and sugary drinks.

The patient should limit fatty foods.

Cholecystitis. inflammation of the gallbladder. is most commonly caused by the presence of gallstones. which may block bile (necessary for fat absorption) from entering the intestines. Patients should decrease dietary fat by limiting foods like fatty meats. fried foods. and creamy desserts to avoid irritation of the gallbladder.

Explanation

Cholecystitis. inflammation of the gallbladder. is most commonly caused by the presence of gallstones. which may block bile (necessary for fat absorption) from entering the intestines. Patients should decrease dietary fat by limiting foods like fatty meats. fried foods. and creamy desserts to avoid irritation of the gallbladder.

5. Which of the following conditions most commonly causes acute glomerulonephritis?

A congenital condition leading to renal dysfunction.

Prior infection with group A Streptococcus within the past 10-14 days.

Viral infection of the glomeruli.

Nephrotic syndrome.

Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection. resulting in scant. dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.

Explanation

Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection. resulting in scant. dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.

6. An infant with hydrocele is seen in the clinic for a follow-up visit at 1 month of age. The scrotum is smaller than it was at birth. but fluid is still visible on illumination. Which of the following actions is the physician likely to recommend?

Massaging the groin area twice a day until the fluid is gone.

Referral to a surgeon for repair.

No treatment is necessary; the fluid is reabsorbing normally.

Keeping the infant in a flat. supine position until the fluid is gone.

A hydrocele is a collection of fluid in the scrotum that results from a patent tunica vaginalis. Illumination of the scrotum with a pocket light demonstrates the clear fluid. In most cases the fluid reabsorbs within the first few months of life and no treatment is necessary. Massaging the area or placing the infant in a supine position would have no effect. Surgery is not indicated.

Explanation

A hydrocele is a collection of fluid in the scrotum that results from a patent tunica vaginalis. Illumination of the scrotum with a pocket light demonstrates the clear fluid. In most cases the fluid reabsorbs within the first few months of life and no treatment is necessary. Massaging the area or placing the infant in a supine position would have no effect. Surgery is not indicated.

7. A physician has diagnosed acute gastritis in a clinic patient. Which of the following medications would be contraindicated for this patient?

Naproxen sodium (Naprosyn).

Calcium carbonate.

Clarithromycin (Biaxin).

Furosemide (Lasix).

Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the upper GI tract. For this reason. it is contraindicated in a patient with gastritis. Calcium carbonate is used as an antacid for the relief of indigestion and is not contraindicated. Clarithromycin is an antibacterial often used for the treatment of Helicobacter pylori in gastritis. Furosemide is a loop diuretic and is contraindicated in a patient with gastritis.

Explanation

Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the upper GI tract. For this reason. it is contraindicated in a patient with gastritis. Calcium carbonate is used as an antacid for the relief of indigestion and is not contraindicated. Clarithromycin is an antibacterial often used for the treatment of Helicobacter pylori in gastritis. Furosemide is a loop diuretic and is contraindicated in a patient with gastritis.

8. A child is admitted to the hospital with a diagnosis of Wilms tumor. stage II. Which of the following statements most accurately describes this stage?

The tumor is less than 3 cm. in size and requires no chemotherapy.

The tumor did not extend beyond the kidney and was completely resected.

The tumor extended beyond the kidney but was completely resected.

The tumor has spread into the abdominal cavity and cannot be resected.

The staging of Wilms tumor is confirmed at surgery as follows: Stage I. the tumor is limited to the kidney and completely resected; stage II. the tumor extends beyond the kidney but is completely resected; stage III. residual non hematogenous tumor is confined to the abdomen; stage IV. hematogenous metastasis has occurred with spread beyond the abdomen; and stage V. bilateral renal involvement is present at diagnosis.

Explanation

The staging of Wilms tumor is confirmed at surgery as follows: Stage I. the tumor is limited to the kidney and completely resected; stage II. the tumor extends beyond the kidney but is completely resected; stage III. residual non hematogenous tumor is confined to the abdomen; stage IV. hematogenous metastasis has occurred with spread beyond the abdomen; and stage V. bilateral renal involvement is present at diagnosis.

9. A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema. Which of the following symptoms should the nurse expect the patient to exhibit?

Slow. deep respirations.

Stridor.

Bradycardia.

Air hunger.

Patients with pulmonary edema experience air hunger. anxiety. and agitation. Respiration is fast and shallow and heart rate increases. Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.

Explanation

Patients with pulmonary edema experience air hunger. anxiety. and agitation. Respiration is fast and shallow and heart rate increases. Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.

10. A teen patient is admitted to the hospital by his physician who suspects a diagnosis of acute glomerulonephritis. Which of the following findings is consistent with this diagnosis? Note: More than one answer may be correct.

Urine specific gravity of 1.040.

Urine output of 350 ml in 24 hours.

Brown (“tea-colored”) urine.

Generalized edema.

Acute glomerulonephritis is characterized by high urine specific gravity related to oliguria as well as dark “tea colored” urine caused by large amounts of red blood cells. There is periorbital edema. but generalized edema is seen in nephrotic syndrome. not acute glomerulonephritis.

Explanation

Acute glomerulonephritis is characterized by high urine specific gravity related to oliguria as well as dark “tea colored” urine caused by large amounts of red blood cells. There is periorbital edema. but generalized edema is seen in nephrotic syndrome. not acute glomerulonephritis.

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