NCLEX Practice Exam 9 (10 Questions)

1. A nurse calls a physician with the concern that a patient has developed a pulmonary embolism. Which of the following symptoms has the nurse most likely observed?

The patient is somnolent with decreased response to the family.

The patient suddenly complains of chest pain and shortness of breath.

The patient has developed a wet cough and the nurse hears crackles on auscultation of the lungs.

The patient has a fever. chills. and loss of appetite.

Typical symptoms of pulmonary embolism include chest pain. shortness of breath. and severe anxiety. The physician should be notified immediately. A patient with pulmonary embolism will not be sleepy or have a cough with crackles on exam. A patient with fever. chills and loss of appetite may be developing pneumonia.

Explanation

Typical symptoms of pulmonary embolism include chest pain. shortness of breath. and severe anxiety. The physician should be notified immediately. A patient with pulmonary embolism will not be sleepy or have a cough with crackles on exam. A patient with fever. chills and loss of appetite may be developing pneumonia.

2. A nurse caring for several patients on the cardiac unit is told that one is scheduled for implantation of an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this procedure?

A patient admitted for myocardial infarction without cardiac muscle damage.

A post-operative coronary bypass patient. recovering on schedule.

A patient with a history of ventricular tachycardia and syncopal episodes.

A patient with a history of atrial tachycardia and fatigue.

An automatic internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. This is necessary in a patient with significant ventricular symptoms. such as tachycardia resulting in syncope. A patient with myocardial infarction that resolved with no permanent cardiac damage would not be a candidate. A patient recovering well from coronary bypass would not need the device. Atrial tachycardia is less serious and is treated conservatively with medication and cardioversion as a last resort.

Explanation

An automatic internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. This is necessary in a patient with significant ventricular symptoms. such as tachycardia resulting in syncope. A patient with myocardial infarction that resolved with no permanent cardiac damage would not be a candidate. A patient recovering well from coronary bypass would not need the device. Atrial tachycardia is less serious and is treated conservatively with medication and cardioversion as a last resort.

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. A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of the following is a contraindication to the study for this patient?

The patient is allergic to shellfish.

The patient has a pacemaker.

The patient suffers from claustrophobia.

The patient takes anti-psychotic medication.

The implanted pacemaker will interfere with the magnetic fields of the MRI scanner and may be deactivated by them. Shellfish/iodine allergy is not a contraindication because the contrast used in MRI scanning is not iodine-based. Open MRI scanners and anti-anxiety medications are available for patients with claustrophobia. Psychiatric medication is not a contraindication to MRI scanning.

Explanation

The implanted pacemaker will interfere with the magnetic fields of the MRI scanner and may be deactivated by them. Shellfish/iodine allergy is not a contraindication because the contrast used in MRI scanning is not iodine-based. Open MRI scanners and anti-anxiety medications are available for patients with claustrophobia. Psychiatric medication is not a contraindication to MRI scanning.

5. A patient with leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC (complete blood count) reveals a platelet count of 25.000/microliter. Which of the following actions related specifically to the platelet count should be included in the nursing care plan?

Monitor for fever every 4 hours.

Require visitors to wear respiratory masks and protective clothing.

Consider transfusion of packed red blood cells.

Check for signs of bleeding. including examination of urine and stool for blood.

A platelet count of 25.000/microliter is severely thrombocytopenic and should prompt the initiation of bleeding precautions. including monitoring urine and stool for evidence of bleeding. Monitoring for fever and requiring protective clothing are indicated to prevent infection if white blood cells are decreased. Transfusion of red cells is indicated for severe anemia.

Explanation

A platelet count of 25.000/microliter is severely thrombocytopenic and should prompt the initiation of bleeding precautions. including monitoring urine and stool for evidence of bleeding. Monitoring for fever and requiring protective clothing are indicated to prevent infection if white blood cells are decreased. Transfusion of red cells is indicated for severe anemia.

6. A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?

The patient will be admitted to the medicine unit for observation and medication.

The patient will be admitted to the day surgery unit for sclerotherapy.

The patient will be admitted to the surgical unit and resection will be scheduled.

The patient will be discharged home to follow-up with his cardiologist in 24 hours.

A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and should be resected as soon as possible. No other appropriate treatment options currently exist.

Explanation

A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and should be resected as soon as possible. No other appropriate treatment options currently exist.

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.