NCLEX Practice Exam MCQ Quiz!

1. A client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of cancer. The nurse anticipates that which of the following may be prescribed?

Radiation

Chemotherapy

Increased fluid intake

Serum sodium blood levels

Decreased oral sodium intake

Medication that is antagonistic to antidiuretic hormone (ADH)

Cancer is a common cause of SIADH. In clients with SIADH. excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. SIADH is managed by treating the condition and its cause. and treatment usually includes fluid restriction. increased sodium intake. and a medication with a mechanism of action that is antagonistic to ADH. Sodium levels are monitored closely. because hypernatremia can suddenly develop as a result of treatment. The immediate institution of appropriate cancer therapy (usually either radiation or chemotherapy) can cause tumor regression so that ADH synthesis and release processes return to normal.

Explanation

Cancer is a common cause of SIADH. In clients with SIADH. excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. SIADH is managed by treating the condition and its cause. and treatment usually includes fluid restriction. increased sodium intake. and a medication with a mechanism of action that is antagonistic to ADH. Sodium levels are monitored closely. because hypernatremia can suddenly develop as a result of treatment. The immediate institution of appropriate cancer therapy (usually either radiation or chemotherapy) can cause tumor regression so that ADH synthesis and release processes return to normal.

Submit

2. A child has been diagnosed with meningococcal meningitis. Which of the following isolation techniques is appropriate?

Enteric precautions

Neutropenic precautions

No precautions are required as long as antibiotics have been started.

Isolation precautions for at least 24 hours after the initiation of antibiotics

Meningococcal meningitis is transmitted primarily by droplet infection. Isolation is begun and maintained for at least 24 hours after antibiotics are given. Options 1. 2. and 3 are incorrect.

Explanation

Meningococcal meningitis is transmitted primarily by droplet infection. Isolation is begun and maintained for at least 24 hours after antibiotics are given. Options 1. 2. and 3 are incorrect.

3. A client has died. and a nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. The nurse's appropriate action is to:

Show acceptance of feelings.

Provide information needed for decision making.

Suggest a referral to a mental health professional.

Remain with the family member without discussing funeral arrangements.

The family member is exhibiting the first stage of grief (denial). and the nurse should remain with the family member. Option 1 is an appropriate intervention for the acceptance or reorganization and restitution stage. Option 2 may be an appropriate intervention for the bargaining stage. Option 3 may be an appropriate intervention for depression.

Explanation

The family member is exhibiting the first stage of grief (denial). and the nurse should remain with the family member. Option 1 is an appropriate intervention for the acceptance or reorganization and restitution stage. Option 2 may be an appropriate intervention for the bargaining stage. Option 3 may be an appropriate intervention for depression.

4. A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic. and the nurse prepares to implement protective isolation procedures. Which interventions would the nurse initiate?

Restrict all visitors.

Place the child on a low-bacteria diet.

Change dressings using sterile technique.

Encourage the consumption of fresh fruits and vegetables.

Perform meticulous hand washing before caring for the child.

Allow fresh-cut flowers in the room as long as they are kept in a vase with fresh water.

For the hospitalized neutropenic child. flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas. to which these children are very susceptible. Fruits and vegetables not peeled before being eaten harbor molds and should be avoided until the white blood cell count rises. The child is placed on a low-bacteria diet. Dressings are always changed with sterile technique. Not all visitors need to be restricted. but anyone who is ill should not be allowed in the child’s room. Meticulous hand washing is required before caring for the child. In addition. gloves. a mask. and a gown is worn (per agency policy).

Explanation

For the hospitalized neutropenic child. flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas. to which these children are very susceptible. Fruits and vegetables not peeled before being eaten harbor molds and should be avoided until the white blood cell count rises. The child is placed on a low-bacteria diet. Dressings are always changed with sterile technique. Not all visitors need to be restricted. but anyone who is ill should not be allowed in the child’s room. Meticulous hand washing is required before caring for the child. In addition. gloves. a mask. and a gown is worn (per agency policy).

Submit

5. A client enters the emergency department confused. twitching. and having seizures. His family states he recently was placed on corticosteroids for arthritis and was feeling better and exercising daily. On data collection. he has flushed skin. dry mucous membranes. an elevated temperature. and poor skin turgor. His serum sodium level is 172 mEq/L. Choose the interventions that the health care provider would likely prescribe.

Monitor intake and output.

Monitor vital signs.

Maintain sodium-reduced diet.

Monitor electrolyte levels.

Increase water intake orally.

Administer sodium replacements.

Hypernatremia is described as having a serum sodium level that exceeds 145 mEq/L. Signs and symptoms would include dry mucous membranes. loss of skin turgor. thirst. flushed skin. elevated temperature. oliguria. muscle twitching. fatigue. confusion. and seizures. Interventions include monitoring fluid balance. monitoring vital signs. reducing the dietary intake of sodium. monitoring electrolyte levels. and increasing oral intake of water. Sodium replacement therapy would not be prescribed for a client with hypernatremia.

Explanation

Hypernatremia is described as having a serum sodium level that exceeds 145 mEq/L. Signs and symptoms would include dry mucous membranes. loss of skin turgor. thirst. flushed skin. elevated temperature. oliguria. muscle twitching. fatigue. confusion. and seizures. Interventions include monitoring fluid balance. monitoring vital signs. reducing the dietary intake of sodium. monitoring electrolyte levels. and increasing oral intake of water. Sodium replacement therapy would not be prescribed for a client with hypernatremia.

Submit

6. A 16-year-old child is brought to the emergency department by his mother with a complaint that the child just experienced a tonic-clonic seizure. On arrival in the emergency department, no apparent seizures were occurring. The mother states that her son is taking medication for the seizure disorder. The nurse plans care. knowing that which of the following medications are used for long-term control of tonic-clonic seizures?

Diazepam (Valium)

Alprazolam (Xanax)

Gabapentin (Neurontin)

Ethosuximide (Zarontin)

Carbamazepine (Tegretol)

Methylphenidate (Ritalin)

Medications that are prescribed for long-term control of tonic-clonic seizures are gabapentin. ethosuximide. and carbamazepine. Diazepam is a medication that is prescribed to halt tonic-clonic episodes. and methylphenidate is a medication used to treat attention deficit hyperactivity disorder. Both of these medications are not suitable for long-term control of a seizure condition. Alprazolam is a medication used to treat anxiety.

Explanation

Medications that are prescribed for long-term control of tonic-clonic seizures are gabapentin. ethosuximide. and carbamazepine. Diazepam is a medication that is prescribed to halt tonic-clonic episodes. and methylphenidate is a medication used to treat attention deficit hyperactivity disorder. Both of these medications are not suitable for long-term control of a seizure condition. Alprazolam is a medication used to treat anxiety.

Submit

7. A client is scheduled for a myelogram. and the nurse provides a list of instructions to the client regarding preparation for the procedure. Which instructions should the nurse place on the list?

Jewelry will need to be removed.

An informed consent will need to be signed.

A trained x-ray technician performs the procedure.

The procedure will take approximately 45 minutes.

A liquid diet can be consumed on the day of the procedure.

Solid food intake needs to be restricted only on the day of the procedure.

Client preparation for a myelogram includes instructing the client to restrict food and fluids for 4 to 8 hours before the procedure. The client is told that the procedure takes about 45 minutes. Informed consent is required because the procedure is invasive and is therefore performed by the health care provider. The client will need to remove jewelry and metal objects from the chest area. The client is also told that pretest medications may be prescribed for relaxation.

Explanation

Client preparation for a myelogram includes instructing the client to restrict food and fluids for 4 to 8 hours before the procedure. The client is told that the procedure takes about 45 minutes. Informed consent is required because the procedure is invasive and is therefore performed by the health care provider. The client will need to remove jewelry and metal objects from the chest area. The client is also told that pretest medications may be prescribed for relaxation.

Submit

8. The clinic nurse is assisting to perform a focused data collection process on a client who is complaining of symptoms of a cold. a cough. and lung congestion. Which of the following would the nurse include for this type of data collection?

Auscultating lung sounds

Obtaining the client’s temperature

Checking the strength of peripheral pulses

Obtaining information about the client’s respirations

Performing a musculoskeletal and neurological examination

Asking the client about a family history of any illness or disease

A focused data collection process focuses on a limited or short-term problem. such as the client’s complaint. Because the client is complaining of symptoms of a cold. a cough. and lung congestion the nurse would focus on the respiratory system and the presence of an infection. A complete data collection includes a complete health history and physical examination and forms a baseline database. Checking the strength of peripheral pulses relates to a vascular assessment. which is not related to this client’s complaints. A musculoskeletal and neurological examination also is not related to this client’s complaints. However. strength of peripheral pulses and a musculoskeletal and neurological examination would be included in a complete data collection. Likewise. asking the client about a family history of any illness or disease would be included in a complete assessment.

Explanation

A focused data collection process focuses on a limited or short-term problem. such as the client’s complaint. Because the client is complaining of symptoms of a cold. a cough. and lung congestion the nurse would focus on the respiratory system and the presence of an infection. A complete data collection includes a complete health history and physical examination and forms a baseline database. Checking the strength of peripheral pulses relates to a vascular assessment. which is not related to this client’s complaints. A musculoskeletal and neurological examination also is not related to this client’s complaints. However. strength of peripheral pulses and a musculoskeletal and neurological examination would be included in a complete data collection. Likewise. asking the client about a family history of any illness or disease would be included in a complete assessment.

Submit

9. A client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of cancer. The nurse anticipates that which of the following may be prescribed?

Radiation

Chemotherapy

Increased fluid intake

Serum sodium blood levels

Decreased oral sodium intake

Medication that is antagonistic to antidiuretic hormone (ADH)

Cancer is a common cause of SIADH. In clients with SIADH. excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. SIADH is managed by treating the condition and its cause. and treatment usually includes fluid restriction. increased sodium intake. and a medication with a mechanism of action that is antagonistic to ADH. Sodium levels are monitored closely. because hypernatremia can suddenly develop as a result of treatment. The immediate institution of appropriate cancer therapy (usually either radiation or chemotherapy) can cause tumor regression so that ADH synthesis and release processes return to normal.

Explanation

Cancer is a common cause of SIADH. In clients with SIADH. excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. SIADH is managed by treating the condition and its cause. and treatment usually includes fluid restriction. increased sodium intake. and a medication with a mechanism of action that is antagonistic to ADH. Sodium levels are monitored closely. because hypernatremia can suddenly develop as a result of treatment. The immediate institution of appropriate cancer therapy (usually either radiation or chemotherapy) can cause tumor regression so that ADH synthesis and release processes return to normal.

Submit

10. A client with a closed head injury is receiving phenytoin (Dilantin). an anticonvulsant medication. Which of the following would indicate that the client is experiencing side effects related to this medication?

Ataxia

Sedation

Constipation

Bleeding gums

Hyperglycemia

Decreased platelet count

Dilantin causes blood dyscrasias. such as decreased platelet counts and decreased white blood cell counts; it contributes to constipation as well. Gingival hyperplasia can occur. causing gums to bleed easily. and blood glucose levels can elevate when taking phenytoin. Sedation is a side effect of barbiturates. not phenytoin. Ataxia is a side effect of benzodiazepines.

Explanation

Dilantin causes blood dyscrasias. such as decreased platelet counts and decreased white blood cell counts; it contributes to constipation as well. Gingival hyperplasia can occur. causing gums to bleed easily. and blood glucose levels can elevate when taking phenytoin. Sedation is a side effect of barbiturates. not phenytoin. Ataxia is a side effect of benzodiazepines.

Submit