NCLEX Practice Exam 47 (10 Questions)

1. Thrombolytic therapy is frequently used in the treatment of suspected stroke. Which of the following is a significant complication associated with thrombolytic therapy?

Air embolus.

Cerebral hemorrhage.

Expansion of the clot.

Resolution of the clot.

Cerebral hemorrhage is a significant risk when treating a stroke victim with thrombolytic therapy intended to dissolve a suspected clot. Success of the treatment demands that it be instituted as soon as possible. often before the cause of stroke has been determined. Air embolism is not a concern. Thrombolytic therapy does not lead to expansion of the clot. but to resolution. which is the intended effect.

Explanation

Cerebral hemorrhage is a significant risk when treating a stroke victim with thrombolytic therapy intended to dissolve a suspected clot. Success of the treatment demands that it be instituted as soon as possible. often before the cause of stroke has been determined. Air embolism is not a concern. Thrombolytic therapy does not lead to expansion of the clot. but to resolution. which is the intended effect.

2. An adolescent brings a physician's note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?

The condition was caused by the student’s competitive swimming schedule.

The student will most likely require surgical intervention.

The student experiences pain in the inferior aspect of the knee.

The student is trying to avoid participation in physical education.

Osgood-Schlatter disease occurs in adolescents in rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle. causing pain and swelling in the inferior aspect of the knee. Osgood-Schlatter disease is commonly caused by activities that require repeated use of the quadriceps. including track and soccer. Swimming is not a likely cause. The condition is usually self-limited. responding to ice. rest. and analgesics. Continued participation will worsen the condition and the symptoms.

Explanation

Osgood-Schlatter disease occurs in adolescents in rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle. causing pain and swelling in the inferior aspect of the knee. Osgood-Schlatter disease is commonly caused by activities that require repeated use of the quadriceps. including track and soccer. Swimming is not a likely cause. The condition is usually self-limited. responding to ice. rest. and analgesics. Continued participation will worsen the condition and the symptoms.

3. A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle. resulting in head trauma. Which of the following signs or symptoms would be cause for concern?

Bulging anterior fontanel.

Repeated vomiting.

Signs of sleepiness at 10 PM.

Inability to read short words from a distance of 18 inches.

Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life threatening. Repeated vomiting can be an early sign of pressure as the vomit center within the medulla is stimulated. The anterior fontanel is closed in a 4-year-old child. Evidence of sleepiness at 10 PM is normal for a four year old. The average 4-year-old child cannot read yet. so this too is normal.

Explanation

Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life threatening. Repeated vomiting can be an early sign of pressure as the vomit center within the medulla is stimulated. The anterior fontanel is closed in a 4-year-old child. Evidence of sleepiness at 10 PM is normal for a four year old. The average 4-year-old child cannot read yet. so this too is normal.

4. The clinic nurse asks a 13-year-old female to bend forward at the waist with arms hanging freely. Which of the following assessments is the nurse most likely conducting?

Spinal flexibility.

Leg length disparity.

Hypostatic blood pressure.

Scoliosis.

A check for scoliosis. a lateral deviation of the spine. is an important part of the routine adolescent exam. It is assessed by having the teen bend at the waist with arms dangling. while observing for lateral curvature and uneven rib level. Scoliosis is more common in female adolescents. Choices A. B. and C are not part of the routine adolescent exam.

Explanation

A check for scoliosis. a lateral deviation of the spine. is an important part of the routine adolescent exam. It is assessed by having the teen bend at the waist with arms dangling. while observing for lateral curvature and uneven rib level. Scoliosis is more common in female adolescents. Choices A. B. and C are not part of the routine adolescent exam.

5. A clinic nurse interviews a parent who is suspected of abusing her child. Which of the following characteristics is the nurse LEAST likely to find in an abusing parent?

Low self-esteem.

Unemployment.

Self-blame for the injury to the child.

Single status.

The profile of a parent at risk of abusive behavior includes a tendency to blame the child or others for the injury sustained. These parents also have a high incidence of low self-esteem. unemployment. unstable financial situation. and single status.

Explanation

The profile of a parent at risk of abusive behavior includes a tendency to blame the child or others for the injury sustained. These parents also have a high incidence of low self-esteem. unemployment. unstable financial situation. and single status.

6. An infant is brought to the clinic by his mother. who has noticed that he holds his head in an unusual position and always faces to one side. Which of the following is the most likely explanation?

Torticollis. with shortening of the sternocleidomastoid muscle.

Craniosynostosis. with premature closure of the cranial sutures.

Plagiocephaly. with flattening of one side of the head.

Hydrocephalus. with increased head size.

In torticollis. the sternocleidomastoid muscle is contracted. limiting range of motion of the neck and causing the chin to point to the opposing side. In craniosynostosis one of the cranial sutures. often the sagittal. closes prematurely. causing the head to grow in an abnormal shape. Plagiocephaly refers to the flattening of one side of the head. caused by the infant being placed supine in the same position over time. Hydrocephalus is caused by a build-up of cerebrospinal fluid in the brain resulting in large head size.

Explanation

In torticollis. the sternocleidomastoid muscle is contracted. limiting range of motion of the neck and causing the chin to point to the opposing side. In craniosynostosis one of the cranial sutures. often the sagittal. closes prematurely. causing the head to grow in an abnormal shape. Plagiocephaly refers to the flattening of one side of the head. caused by the infant being placed supine in the same position over time. Hydrocephalus is caused by a build-up of cerebrospinal fluid in the brain resulting in large head size.

7. A child weighing 30 kg arrives at the clinic with diffuse itching as the result of an allergic reaction to an insect bite. Diphenhydramine (Benadryl) 25 mg 3 times a day is prescribed. The correct pediatric dose is 5 mg/kg/day. Which of the following best describes the prescribed drug dose?

It is the correct dose.

The dose is too low.

The dose is too high.

The dose should be increased or decreased. depending on the symptoms.

This child weighs 30 kg. and the pediatric dose of diphenhydramine is 5 mg/kg/day (5 X 30 = 150/day). Therefore. the correct dose is 150 mg/day. Divided into 3 doses per day. the child should receive 50 mg 3 times a day rather than 25 mg 3 times a day. Dosage should not be titrated based on symptoms without consulting a physician.

Explanation

This child weighs 30 kg. and the pediatric dose of diphenhydramine is 5 mg/kg/day (5 X 30 = 150/day). Therefore. the correct dose is 150 mg/day. Divided into 3 doses per day. the child should receive 50 mg 3 times a day rather than 25 mg 3 times a day. Dosage should not be titrated based on symptoms without consulting a physician.

8. The mother of a 2-month-old infant brings the child to the clinic for a well baby check. She is concerned because she feels only one testis in the scrotal sac. Which of the following statements about the undescended testis is the most accurate?

Normally. the testes are descended by birth.

The infant will likely require surgical intervention.

The infant probably has with only one testis.

Normally. the testes descend by one year of age.

Normally. the testes descend by one year of age. In young infants. it is common for the testes to retract into the inguinal canal when the environment is cold or the cremasteric reflex is stimulated. Exam should be done in a warm room with warm hands. It is most likely that both testes are present and will descend by a year. If not. a full assessment will determine the appropriate treatment.

Explanation

Normally. the testes descend by one year of age. In young infants. it is common for the testes to retract into the inguinal canal when the environment is cold or the cremasteric reflex is stimulated. Exam should be done in a warm room with warm hands. It is most likely that both testes are present and will descend by a year. If not. a full assessment will determine the appropriate treatment.

9. A nonimmunized child appears at the clinic with a visible rash. Which of the following observations indicates the child may have rubeola (measles)?

Small blue-white spots are visible on the oral mucosa.

The rash begins on the trunk and spreads outward.

There is low-grade fever.

The lesions have a “teardrop on a rose petal” appearance.

Koplik’s spots are small blue-white spots visible on the oral mucosa and are characteristic of measles infection. The body rash typically begins on the face and travels downward. High fever is often present. “Tear drop on a rose petal” refers to the lesions found in varicella (chicken pox).

Explanation

Koplik’s spots are small blue-white spots visible on the oral mucosa and are characteristic of measles infection. The body rash typically begins on the face and travels downward. High fever is often present. “Tear drop on a rose petal” refers to the lesions found in varicella (chicken pox).

10. A child is seen in the emergency department for scarlet fever. Which of the following descriptions of scarlet fever is NOT correct?

Scarlet fever is caused by infection with group A Streptococcus bacteria.

“Strawberry tongue” is a characteristic sign.

Petechiae occur on the soft palate.

The pharynx is red and swollen.

Petechiae on the soft palate are characteristic of rubella infection. Choices A. B. and D are characteristic of scarlet fever. a result of group A Streptococcus infection.

Explanation

Petechiae on the soft palate are characteristic of rubella infection. Choices A. B. and D are characteristic of scarlet fever. a result of group A Streptococcus infection.