NCLEX Practice Exam 10 (10 Questions)

1. 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.

2. A nurse is providing discharge information to a patient with peripheral vascular disease. Which of the following information should be included in instructions?

Walk barefoot whenever possible.

Use a heating pad to keep feet warm.

Avoid crossing the legs.

Use antibacterial ointment to treat skin lesions at risk of infection.

Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Walking barefoot is not advised. as foot protection is important to avoid trauma that may lead to serious infection. Heating pads can cause injury. which can also increase the risk of infection. Skin lesions at risk for infection should be examined and treated by a physician.

Explanation

Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Walking barefoot is not advised. as foot protection is important to avoid trauma that may lead to serious infection. Heating pads can cause injury. which can also increase the risk of infection. Skin lesions at risk for infection should be examined and treated by a physician.

3. A patient in the cardiac unit is concerned about the risk factors associated with atherosclerosis. Which of the following are hereditary risk factors for developing atherosclerosis?

Family history of heart disease.

Overweight.

Smoking.

Age.

Family history of heart disease is an inherited risk factor that is not subject to lifestyle change. Having a first-degree relative with heart disease has been shown to significantly increase risk. Overweight and smoking are risk factors that are subject to lifestyle change and can reduce risk significantly. Advancing age increases the risk of atherosclerosis but is not a hereditary factor.

Explanation

Family history of heart disease is an inherited risk factor that is not subject to lifestyle change. Having a first-degree relative with heart disease has been shown to significantly increase risk. Overweight and smoking are risk factors that are subject to lifestyle change and can reduce risk significantly. Advancing age increases the risk of atherosclerosis but is not a hereditary factor.

4. 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.

5. A 23-year-old patient in the 27th week of pregnancy has been hospitalized on complete bed rest for 6 days. She experiences sudden shortness of breath. accompanied by chest pain. Which of the following conditions is the most likely cause of her symptoms?

Myocardial infarction due to a history of atherosclerosis.

Pulmonary embolism due to deep vein thrombosis (DVT).

Anxiety attack due to worries about her baby’s health.

Congestive heart failure due to fluid overload.

In a hospitalized patient on prolonged bed rest. the most likely cause of sudden onset shortness of breath and chest pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep veins of the legs. These clots can then break loose and travel to the lungs. Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman. as is congestive heart failure due to fluid overload. There is no reason to suspect an anxiety disorder in this patient. Though anxiety is a possible cause of her symptoms. the seriousness of pulmonary embolism demands that it be considered first.

Explanation

In a hospitalized patient on prolonged bed rest. the most likely cause of sudden onset shortness of breath and chest pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep veins of the legs. These clots can then break loose and travel to the lungs. Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman. as is congestive heart failure due to fluid overload. There is no reason to suspect an anxiety disorder in this patient. Though anxiety is a possible cause of her symptoms. the seriousness of pulmonary embolism demands that it be considered first.

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 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 Wilm’s 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 nonhematogenous 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 Wilm’s 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 nonhematogenous 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.

8. Claudication is a well-known effect of peripheral vascular disease. Which of the following facts about claudication is correct? Select all that apply:

It results when oxygen demand is greater than oxygen supply.

It is characterized by pain that often occurs during rest.

It is a result of tissue hypoxia.

It is characterized by cramping and weakness.

Claudication describes the pain experienced by a patient with peripheral vascular disease when oxygen demand in the leg muscles exceeds the oxygen supply. This most often occurs during activity when demand increases in muscle tissue. The tissue becomes hypoxic. causing cramping. weakness. and discomfort.

Explanation

Claudication describes the pain experienced by a patient with peripheral vascular disease when oxygen demand in the leg muscles exceeds the oxygen supply. This most often occurs during activity when demand increases in muscle tissue. The tissue becomes hypoxic. causing cramping. weakness. and discomfort.

9. A patient who has been diagnosed with vasospastic disorder (Raynaud's disease) complains of cold and stiffness in the fingers. Which of the following descriptions is most likely to fit the patient?

An adolescent male.

An elderly woman.

A young woman.

An elderly man.

Raynaud’s disease is most common in young women and is frequently associated with rheumatologic disorders. such as lupus and rheumatoid arthritis.

Explanation

Raynaud’s disease is most common in young women and is frequently associated with rheumatologic disorders. such as lupus and rheumatoid arthritis.

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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