NCLEX Practice Exam 17 (10 Questions)

1. There are a number of risk factors associated with coronary artery disease. Which of the following is a modifiable risk factor?

Obesity.

Heredity.

Gender.

Age.

Obesity is an important risk factor for coronary artery disease that can be modified by improved diet and weight loss. Family history of coronary artery disease. male gender. and advancing age increase risk but cannot be modified.

Explanation

Obesity is an important risk factor for coronary artery disease that can be modified by improved diet and weight loss. Family history of coronary artery disease. male gender. and advancing age increase risk but cannot be modified.

2. A hospitalized patient is receiving packed red blood cells (PRBCs) for treatment of severe anemia. Which of the following is the most accurate statement?

Transfusion reaction is most likely immediately after the infusion is completed.

PRBCs are best infused slowly through a 20g. IV catheter.

PRBCs should be flushed with a 5% dextrose solution.

A nurse should remain in the room during the first 15 minutes of infusion.

Transfusion reaction is most likely during the first 15 minutes of infusion. and a nurse should be present during this period. PRBCs should be infused through a 19g or larger IV catheter to avoid slow flow. which can cause clotting. PRBCs must be flushed with 0.45% normal saline solution. Other intravenous solutions will hemolyze the cells.

Explanation

Transfusion reaction is most likely during the first 15 minutes of infusion. and a nurse should be present during this period. PRBCs should be infused through a 19g or larger IV catheter to avoid slow flow. which can cause clotting. PRBCs must be flushed with 0.45% normal saline solution. Other intravenous solutions will hemolyze the cells.

3. Following myocardial infarction. a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient?

Increases fitness and prevents future heart attacks.

Prevents bedsores.

Prevents DVT (deep vein thrombosis).

Prevent constipations.

Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase physical fitness. nor is it intended to prevent bedsores or constipation.

Explanation

Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase physical fitness. nor is it intended to prevent bedsores or constipation.

4. A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the infusion. which of the following symptoms is NOT expected?

Increased urinary output.

Decreased edema.

Decreased pain.

Decreased blood pressure.

Furosemide. a loop diuretic. does not alter pain. Furosemide acts on the kidneys to increase urinary output. Fluid may move from the periphery. decreasing edema. Fluid load is reduced. lowering blood pressure.

Explanation

Furosemide. a loop diuretic. does not alter pain. Furosemide acts on the kidneys to increase urinary output. Fluid may move from the periphery. decreasing edema. Fluid load is reduced. lowering blood pressure.

5. Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA?

Worsening chest pain that began earlier in the evening.

History of cerebral hemorrhage.

History of prior myocardial infarction.

Hypertension.

A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure. as tPA may cause hypotension.

Explanation

A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure. as tPA may cause hypotension.

6. A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse complaining of frequent headaches. Which of the following responses to the patient is correct?

“Stop taking the nitroglycerin and see if the headaches improve.”

“Go to the emergency department to be checked because nitroglycerin can cause bleeding in the brain.”

“Headaches are a frequent side effect of nitroglycerine because it causes vasodilation.”

“The headaches are unlikely to be related to the nitroglycerin. so you should see your doctor for further investigation.”

Nitroglycerin is a potent vasodilator and often produces unwanted effects such as headache. dizziness. and hypotension. Patients should be counseled. and the dose titrated. to minimize these effects. In spite of the side effects. nitroglycerin is effective at reducing myocardial oxygen consumption and increasing blood flow. The patient should not stop the medication. Nitroglycerine does not cause bleeding in the brain.

Explanation

Nitroglycerin is a potent vasodilator and often produces unwanted effects such as headache. dizziness. and hypotension. Patients should be counseled. and the dose titrated. to minimize these effects. In spite of the side effects. nitroglycerin is effective at reducing myocardial oxygen consumption and increasing blood flow. The patient should not stop the medication. Nitroglycerine does not cause bleeding in the brain.

7. A clinic patient has a hemoglobin concentration of 10.8 g/dL and reports sticking to a strict vegetarian diet. Which of the follow nutritional advice is appropriate?

The diet is providing adequate sources of iron and requires no changes.

The patient should add meat to her diet; a vegetarian diet is not advised.

A cup of coffee or tea should be added to every meal.

Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly anemic. When food is prepared in iron cookware its iron content is increased. In addition. dark green leafy vegetables. such as spinach and kale. and legumes are high in iron. Mild anemia does not require that animal sources of iron be added to the diet. Many non-animal sources are available. Coffee and tea increase gastrointestinal activity and inhibit absorption of iron.

Explanation

Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly anemic. When food is prepared in iron cookware its iron content is increased. In addition. dark green leafy vegetables. such as spinach and kale. and legumes are high in iron. Mild anemia does not require that animal sources of iron be added to the diet. Many non-animal sources are available. Coffee and tea increase gastrointestinal activity and inhibit absorption of iron.

8. A patient received surgery and chemotherapy for colon cancer. completing therapy three (3) months previously. and she is now in remission. At a follow-up appointment. she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations could account for her symptoms?

The symptoms may be the result of anemia caused by chemotherapy.

The patient may be immunosuppressed.

The patient may be depressed.

The patient may be dehydrated.

Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects. which often includes anemia because of bone-marrow suppression. There is no evidence that the patient is immunosuppressed. and fatigue is not a typical symptom of immunosuppression. The information given does not indicate that depression or dehydration is a cause of her symptoms.

Explanation

Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects. which often includes anemia because of bone-marrow suppression. There is no evidence that the patient is immunosuppressed. and fatigue is not a typical symptom of immunosuppression. The information given does not indicate that depression or dehydration is a cause of her symptoms.

9. A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform?

Ask the patient to lie down on the exam table.

Draw blood for chemistry panel and arterial blood gas (ABG).

Send the patient for a chest x-ray.

Check blood pressure.

A patient with congestive heart failure and dyspnea may have pulmonary edema. which can cause severe hypertension. Therefore. taking the patient’s blood pressure should be the first action. Lying flat on the exam table would likely worsen the dyspnea. and the patient may not tolerate it. Blood draws for chemistry and ABG will be required. but not prior to the blood pressure assessment.

Explanation

A patient with congestive heart failure and dyspnea may have pulmonary edema. which can cause severe hypertension. Therefore. taking the patient’s blood pressure should be the first action. Lying flat on the exam table would likely worsen the dyspnea. and the patient may not tolerate it. Blood draws for chemistry and ABG will be required. but not prior to the blood pressure assessment.

10. A patient arrives in the emergency department with symptoms of myocardial infarction. progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock?

Hypertension.

Bradycardia.

Bounding pulse.

Confusion.

Cardiogenic shock severely impairs the pumping function of the heart muscle. causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion. as well as hypotension. tachycardia. and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.

Explanation

Cardiogenic shock severely impairs the pumping function of the heart muscle. causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion. as well as hypotension. tachycardia. and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.