2018 NCLEX-PN Test Prep. Questions and Answers with Explanations: Study Guide to Pass the License Exam Effortlessly - Exam Review for Practical Nurses

2018 NCLEX-PN

TEST PREP QUESTIONS AND ANSWERS

WITH EXPLANATIONS

Study Guide to Pass the License Exam Effortlessly

Exam Review for Practical Nurses

Fun Science Group

Copyright Fun Science Group 2018

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First Printing, 2018

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TABLE OF CONTENTS

Introduction

7 Secrets to Studying – How to Pass Any Exam

STUDY MODE:

Practice Exam 1

Practice Exam 2

Practice Exam 3

Practice Exam 4

Practice Exam 5

TEST MODE:

Practice Exam 1

Practice Exam 2

Practice Exam 3

Practice Exam 4

Practice Exam 5

Answer Key

Conclusion

Limits of Liability

INTRODUCTION

Welcome to the NCLEX-PN Test Prep Questions and Answers with Explanations: Study Guide to Passing the License Exam Effortlessly. This book will help you get ready to take and pass the Licensing Exam for Practical Nurses. This book gives you a review of the required information and techniques to obtain licensure.

The NCLEX-PN Test Prep Questions and Answers with Explanations helps you practice taking questions written in the NCLEX® format. This book is targeted at test preparation and review. It does not teach you everything you need to know about the subject of nursing. Instead, they present you with the essential materials that you are likely to face on the exam. Using a simplified approach, this will help you understand the key elements needed to know to pass your exam on the first try.

The NCLEX-PN® is comprised of questions from the cognitive levels of knowledge, comprehension, application, and analysis. The majority of questions here are composed at the application and analysis level. Questions encompass the five stages of the nursing process (assessment, diagnosis, planning, implementation, and evaluation) and the four categories of client needs.

The most effective way to pass the NCLEX® is to review the information you have learned in nursing school and take the time to study it thoroughly. The exam is difficult and those that do not pass will need to take the test again. Do not put off studying. Cramming at the last minute will only lead to a poor outcome. Take your time; allow yourself plenty of study time before the date of your exam. This is an important test and is the measure of the work you will perform as a Practical Nurse.

Good luck and study well!

7 SECRETS TO STUDYING

Hints on How To Pass Any Exam!

Exams! A cause of nervousness, fear, and even terror, yet a necessary rite of passage toward a worthwhile goal.

The good news is there are many things you can do before and during your final exam that will almost guarantee a passing grade.

The two most important things you need are motivation and an effective study plan!

Motivation will take a bit of effort, but it’s the key to achieving your goals. To stay motivated, remember why you took this course and review the benefits you’ll derive from passing the exam and receiving your certificate. Perhaps you’re looking forward to increased income, increased self-respect or self-employment. You enrolled in this course because you’re looking forward to a brighter future!

In the following pages, we’ll provide tips and information on how to create an effective study plan. You’ll discover seven guidelines for creating a worthwhile program for yourself. If you want to do well and you want to put forth the effort, use these simple techniques. They have helped many people succeed, and if you use them, they will work for you as well!

SECRET #1: No Excuses! Make Studying a Habit Worth Having

The very first thing you need to do is accept the fact that studying is a requirement, and a necessary part of the learning process.

Set up a Winning Schedule

Next, set up a schedule and follow it! By doing so, you are developing a HABIT of studying. A habit (as you may already know) takes on a life of its own and starts to generate its own energy, making it easier and easier for you to continue. Remember, consistency is the key to developing a positive study habit.

How to develop a strong, effective study habit:

• Start small. Start with only 10-15 minutes of studying at a time and then build up to longer amounts as you progress in the material.

• Set time aside for studying every day if possible.

• On the other hand, be realistic. Be sure to set up a

reasonable schedule that you can easily follow.

SECRET #2: Create the Right Study Environment

Avoid All Distractions

Try your best to avoid distractions during your study time. Eliminate all the obvious distractions like phone calls, or friends dropping by. Tell your family members, spouse or children that you need time alone to concentrate on your studies. Unplug your phone, shut the door, move the newspaper and magazines to another part of the house. Keep the television and radio off. Take control of your environment!

Don’t Procrastinate!

Don’t be tempted to put off studying for even two or three hours just because the garage needs to be cleaned out, or the closets need reorganizing. Those tasks can wait.

Remember to stick to your schedule.

BONUS TIP: Study Shorter, More Often!

We absorb a lot more information if we learn in small, manageable portions, instead of trying to learn everything at once.

Break it down! Study small sections, take a break, then study

again.

SECRET #2: Create the Right Environment (continued)

Where to Study

Find a quiet, comfortable (but not too comfortable) place to study. If you find too many distractions at home, go to your local library. Find a part of the library that is well-lit and ventilated. This will help you to concentrate. Pack a box with everything you need to study, so that when it’s time to go, you can just pick up the box and take off.

The RIGHT Study Environment:

• Studying in the same place each time will help you concentrate and will reinforce your positive study habits.

• If your exam is proctored, try to recreate the same environment as your final exam. This means that if you will be taking the exam sitting at a desk, make sure you study sitting at a desk. If you do this, you will form an association with knowing the material and sitting at a desk. Make your study situation as similar as possible to the exam situation, and, believe it or not, this will actually help you during the exam!

(Later we’ll talk about forming a mental attitude during study that you will duplicate during the exam.)

The WRONG Study Environment:

• Don’t study lying in bed. Your unconscious mind associates your bed with sleep. You’re more likely to nod off than get any real studying done!

• Don’t study in front of the television set.

• Don’t eat while studying. Food can be the greatest distraction of all!



BONUS TIP: Eat Light & Eat Right

Do you study in the evening? If you feel sluggish, it could be because you ate a heavy meal.

Also stay away from foods high in sugar, like candy bars or chocolate. You’ll get an initial surge, but you’ll soon crash! Instead, eat carbohydrates (bread or pasta), fruits or protein (nuts, meat).





SECRET #3: Maximize Your Time

Take Study Breaks

Make sure you take a break! Periodically stand up, gently rotate your neck, touch your toes and feel the stretch along the back of your legs. If possible, take a short walk to get some fresh air.

Find Your Peak Performance Time

Have you noticed that you’re more alert during a certain time of day? For some, their peak time of day is in the afternoon, while others feel sharpest in the early morning hours. Most people claim they’re either a morning person or a night owl. Which are you? Find out, then study during those hours, whether it’s 7:00 a.m. or midnight. However, don’t study when you’re too tired. It’s a waste of your valuable time and it won’t do you any good!

BONUS TIP: Avoid Cramming!

Cramming is a good way to guarantee poor results. Don’t expect to retain any information you try to learn at the last minute. In the days before your exam, you should review the material you’ve already gone over.

SECRET #4: Use Study Aids to Your Advantage

Plan a review of each chapter as you go along, so that you don’t have to review everything all at once right before the exam. Remember, no cramming!

Make up your own questions for each chapter. Use the chapter headings and subheadings for ideas. Can you answer these questions quickly?

Flash cards are very good tools, particularly for memorization of important terms and definitions. You can create them out of the words and terms you’re having the most difficulty with. Review them in random order until you feel confident that you know them.

Videos, (if offered with your course) are excellent study aids, because watching and listening to videos involve more of your senses than just reading. Plus, videos can be rewound and replayed as often as you need.

Practice exams (if available) can also help prepare you for the real thing. If you can score 90% or more on your practice exams, you’re doing well!

Remember, effective studying is a result of active involvement, not just passively reading the text and materials.

BONUS TIP: Score at least 90% correct on your study aids

Your study aids are a valuable tool! Use them to track your progress. You’ll know instantly which topics you’re weaker on and which areas you need to review again.



SECRET #5: Remember to use Memorization Tools!

Associative Memory Techniques

What’s the best way to recall important facts? When you associate something familiar to you with those facts. Here are some examples of associative memory techniques that will work for you.

Acrostics

Have you ever heard of the phrase, Every good boy does fine? This is an example of an acrostic. The first letter in each word stands for the note on the musical staff — E, G, B, D, F. This is an aid to memory. For instance, in real estate, when you want to remember property tax dates, use the acrostic No Darn Fooling Around (for November, December, February, and April). See if you can make up creative acrostics for areas you need help remembering. Sometimes the more outrageous, the better!

Acronyms

Acronyms are actual words formed from the first letters of a series or list of words you need to remember. In grade school when you had to remember the names of the Great Lakes, you probably used the word homes to remember all five lakes - Huron, Ontario, Michigan, Erie, and Superior. Be creative in making up acronyms for yourself!

Rhymes

Making up a simple rhyme can be a very effective memorization tool. Remember, I before e, except after c?

Imaging Techniques

Visualization engages a different part of your brain than reading or listening, thereby adding to your learning success. You can use LINKING to recall a list or series of words by creating a visualization that contains all the words you need to recall. The more outlandish the image, the more likely you’ll remember it. For instance, say you want to recall the errands you need to run that day. You need to go to the post office, buy milk, pick up your daughter at soccer practice, and buy dog food. Link these together by visualizing a dog with a letter in its mouth being chased by a cow kicking a soccer ball. It might sound strange, but it works!

BONUS TIP: Make Sure You Understand What You Read

NEVER go past a word you don’t understand in the textbook. Stop and look it up, then continue. If you don’t understand a sentence or paragraph in the text, take it a phrase at a time until it makes sense to you. Write down any term you find difficult and make it into a flash card. Review it the next day at the start of your study session. Soon you’ll know them all!

SECRET #5: Remember to use Memorization Tools! (continued)

Other Memory Techniques

Recitation

Probably the most powerful tool you have to transfer ideas from your short-term memory to your long-term memory is to say those ideas out loud and in your own words.

Interest

You’ll remember things better if you are truly interested in remembering them. It may sound simple, but it’s true! Therefore, periodically recall your reasons for taking this course in the first place. Imagine all the benefits of your new career. Keep your goals in sight. This will refresh your interest in learning the material and aid in your study success.

Repetition

Remember, memory is interest plus repetition. Reading and re-reading is helpful, but also say things out loud, write them down, invent acronyms or use the linking technique. Practice what you’ve learned on your family or friends. Have them ask you questions based on the material you’ve studied. We learn through repetition. How do you think we learn the lyrics to a popular song or all those television ad lines and jingles? Because we’ve heard them over and over and over and . . .

SECRET #6: Visualize Your Success and Tame Your Fears!

If you’re like most people, you may have a little discomfort at the thought of taking a quiz or an exam. You may remember past experiences that didn’t work out, or you may focus on how you’ll feel if you don’t do well. Your anxiety may even be intense enough to classify as real fear.

However, it’s important to transform a fearful or negative attitude into a positive attitude, because a positive attitude counts for at least a third of your success on any exam! Luckily, we have the power to focus our attention on thoughts and feelings that serve us better.

BONUS TIP: The past doesn’t equal the future!

Whatever happened before is not destined to happen again. So if you’ve failed in the past, it doesn’t mean you’ll fail in the future. The past is gone, so forget it. Let’s start fresh!

SECRET #6: Visualize Your Fears and Tame Your Success! (continued)

But how do you generate a positive attitude? First, let’s shift our focus away from how we’ll feel if we fail to how we’ll feel when we succeed! Each night (or day) at the end of your study session, visualize yourself receiving your Certificate of Completion. See the words, Congratulations, you’ve passed your course. Smile, take a deep breath, relax and imagine telling your best friend or family member the good news. Enjoy your success. Pat yourself on the back for all that studying and good work. You deserve it!

At first, you may have difficulty visualizing if your fear level is high or if you’ve had a disappointment or two in the past. However, if you persist, little by little, the visualization will become easier. It can actually be quite fun!

Here’s another visualization tip. Remember when we talked about duplicating the same study environment that you’d have during the actual exam as an aid to doing well? Another good visualization technique is to duplicate the mental attitude during study that you’d like to have during the exam.

You’d probably like to be relaxed, confident, clear-minded and alert during the exam. So, before each study session, take a minute to imagine yourself in the exam room, your feet planted on the floor, a clock on the wall in view, your pencils, eraser, and calculator on the desk in front of you. If this makes you nervous — fine. Next, close your eyes and take a long, deep breath. Inhale through your nose, slowly filling up your diaphragm first, then inhaling upward, filling your lungs. Hold your breath to the count of three, then exhale slowly through your mouth while saying the word relax in your mind. As you exhale, imagine your whole body letting go of any tension. Do this three or four times until you feel relaxed. With your eyes still closed, take a moment and concentrate on how it feels to be relaxed. Tell yourself, I am in the exam room and I’m completely relaxed and feeling fine. I feel confident and intelligent! I remember everything I studied. (If you wish, substitute other sentences that feel helpful to you.) If you do this breathing technique and affirmation each time you study, you will develop a relaxation response. This relaxation response will become stronger each time you practice it.

BONUS TIP: Anticipation Jitters are Normal!

Don’t deny what you’re feeling! You’re experiencing anxiety because you realize the importance of passing this exam it’s a natural reaction. However, don’t let this fear paralyze you. Remember your visualization and relaxation techniques.

SECRET #6: Visualize Your Fears and Tame Your Success! (continued)

When you actually find yourself in the exam room, you can close your eyes and repeat this procedure. The relaxation response you developed sitting in your study area will be recalled by your body and will help you relax during the exam. It works!

You can also add a cue to your relaxation response if you’d like. For example, in order to relax during an exam, you can program yourself to deep breathe and relax while gently tapping your index finger on the table. Practice this technique over and over again until your mind associates the relaxation response with the tapping of your finger. Then, if you feel tense when you’re taking the actual exam, all you need to do is gently tap your index finger on the desk and you’ll calm down!

If you psychologically prepare yourself for success, your chances for real success will increase dramatically. Professional athletes frequently use visualization techniques to improve their performance. They don’t allow room for a single negative thought, and neither should you. Tell yourself you’re looking forward to your exam, because it will be the culmination of all your hard work and in the end, you’ll have a rewarding new career!

SECRET #7: Don’t Cram The Night Before - What to Do Instead!

The Day Before the Exam...

If your exam is proctored and you need to drive to the location, make sure you load the car up with gas the day before your exam. Also review the two routes you’ve planned to take to get to the exam location. Think through and write down your pre-exam schedule so that you know when you have to leave the house to arrive at the exam early. Give yourself adequate time to shower, dress, eat, etc. Gather all the materials you’ll need for the exam and put them in a box or bag.

The Night Before...

Some people recommend not studying at all after dinner on the night before the exam. Instead, go for a long walk, or read, or hit some golf balls - whatever relaxes you. If you’ve followed your study schedule and used the suggestions in this booklet, you should be well prepared! Now all you need to do is make sure you get a good night’s sleep. Staying up late, or going out to a party won’t help your test results!

BONUS SECTION: Tips For During The Exam

Regardless of whether your exam is proctored or not, read the directions carefully. Don’t assume you already know what they say. Take nothing for granted. Be sure to note if you’ll be penalized for wrong answers or not. If you’re not penalized for wrong answers, then it’s okay to guess.

Next, do a quick preview of the exam. If you don’t already know how the exam is broken down, this will give you some idea. If any information comes into your mind during the preview, write it down quickly on your scrap paper for use later. Previewing the exam quickly may even give you some answers to questions. Also, your subconscious will be working on the difficult questions you’ve seen before you get to them.

Once you know how the exam breaks down, then you can quickly calculate how much time is reasonable to allot for each section. For instance, an essay question worth only a few points is not worth spending 30 minutes on!

If the exam is all multiple choice, you can calculate how much time each question should take in the following manner. Divide your time into quarterly segments. For instance, if you have 4 hours to complete the exam, and there are 150 questions, then set a goal to finish the exam in 3 hours. (We will explain why later.) Therefore, divide 3 hours by 4 and you’ll get 4 forty-five minute segments. Write down when you should be done with one-quarter of the questions, one- half of the questions, three-quarters of the questions, and finally the whole exam. It will look something like this.

Time Question #

9:00 - 9:45 #1-#39

9:45 - 10:30 #38 - #75

10:30 - 11:15 #76 - #113

11:15 - 12:00 #114 - #150

BONUS SECTION: Tips For During The Exam (continued)

This way, if at 9:45 you’re still on question #12, you’ll know you’re moving too slow. But luckily, you’ve spotted your error early and you have time to pick up speed! If you’re right at question #38, you know you’re on time and doing well. Keep checking your progress periodically.

Work on the easiest parts of the exam first, but be sure to allow enough time for the difficult parts of the exam. If the exam is all multiple-choice questions, then just go ahead sequentially. But if the exam contains some multiple-choice and some essay questions, and you have a definite preference for one type of question over the other, complete the type of question you like better first. As a result, you’ll gain confidence and momentum. Then when you go back to the harder questions, your subconscious mind has already been working on them.

When answering essay questions, write notes in the margin of your scrap paper to help you organize your ideas briefly before writing. Be sure to make your writing easy to read.

Any question you don’t understand can be restated in your own words to make it easier for you to understand. However, be sure not to change the original meaning of the question!

Go Through Your Exam Four Times

You’re going to go through your exam four different times. That’s why we took that extra hour away from your first pass through the exam. This last hour allows you time for the subsequent passes through the exam.

The first time through the exam, skip any questions you don’t know the answers to. Draw a line on your scrap paper, and write down the numbers of those questions you skip.

After you’ve gone all the way through the exam the first time, count how many questions you’ve skipped and quickly calculate how much time you have for each of them, then go back through the exam a second time to answer those questions you’ve skipped. Try to answer them, but don’t take longer than the time you allotted for each one. If you still don’t know the answer, leave it blank.

The third time through the exam, go ahead and guess on those questions you left blank (if you won’t be penalized for guessing).

BONUS SECTION: Tips For During The Exam (continued)

The fourth time through the exam, proofread your answers. When you proofread, you’re looking for these three things: clerical, mathematical or perceptual errors. Did you misunderstand the question? Is the decimal point in the right place? Did you mistakenly pencil in A for answer #23 instead of B ? On the other hand, don’t change any of the answers unless you’re absolutely sure they’re incorrect. Your first instincts are usually right.

It may be difficult for you to review the exam the fourth time. You’re under stress and you may just want to finish as quickly as possible. But don’t give up yet. You’ve worked hard, so see it through. Use all the time you have been allotted for the exam. Don’t leave until the proctor says Time is up!

After The Exam .....

Congratulations! You’ve worked hard, and you’ve done well, so now you can relax. If you’ve faithfully followed these steps, you’ll soon be able to enjoy your success!

Study Mode

Practice Exam 1 (STUDY MODE)

1. The nurse is caring for a client scheduled for removal of a pituitary tumor using the transsphenoidal approach. The nurse should be particularly alert for:

A. Nasal congestion

B. Abdominal tenderness

C. Muscle tetany

D. Oliguria

Answer A: Removal of the pituitary gland is usually done by a transsphenoidal approach, through the nose. Nasal congestion further interferes with the airway. Answers B, C, and D are not correct because they are not directly associated with the pituitary gland.

2. A client with cancer is admitted to the oncology unit. Stat lab values reveal Hgb 12.6, WBC 6500, K+ 1.9, uric acid 7.0, Na+ 136, and platelets 178,000. The nurse evaluates that the client is experiencing which of the following?

A. Hypernatremia

B. Hypokalemia

C. Myelosuppression

D. Leukocytosis

Answer B: Hypokalemia is evident from the lab values listed. The other laboratory findings are within normal limits, making answers A, C, and D incorrect.

3. A 24-year-old female client is scheduled for surgery in the morning. Which of the following is the primary responsibility of the nurse?

A. Taking the vital signs

B. Obtaining the permit

C. Explaining the procedure

D. Checking the lab work

Answer A: The primary responsibility of the nurse is to take the vital signs before any surgery. The actions in answers B, C, and D are the responsibility of the doctor and, therefore, are incorrect for this question.

4. The nurse is working in the emergency room when a client arrives with severe burns of the left arm, hands, face, and neck. Which action should receive priority?

A. Starting an IV

B. Applying oxygen

C. Obtaining blood gases

D. Medicating the client for pain

Answer B: The client with burns to the neck needs airway assessment and supplemental oxygen, so applying oxygen is the priority. The next action should be to start an IV and medicate for pain, making answers A and C incorrect. Answer D, obtaining blood gases, is ordered by the doctor.

5. The nurse is visiting a home health client with osteoporosis. The client has a new prescription for alendronate (Fosamax). Which instruction should be given to the client?

A. Rest in bed after taking the medication for at least 30 minutes

B. Avoid rapid movements after taking the medication

C. Take the medication with water only

D. Allow at least 1 hour between taking the medicine and taking other medications

Answer B: The client with burns to the neck needs airway assessment and supplemental oxygen, so applying oxygen is the priority. The next action should be to start an IV and medicate for pain, making answers A and C incorrect. Answer D, obtaining blood gases, is ordered by the doctor.

6. The nurse is making initial rounds on a client with a C5 fracture and crutchfield tongs. Which equipment should be kept at the bedside?

A. A pair of forceps

B. A torque wrench

C. A pair of wire cutters

D. A screwdriver

Answer B: A torque wrench is kept at the bedside to tighten and loosen the screws of crutchfield tongs. This wrench controls the amount of pressure that is placed on the screws. A pair of forceps, wire cutters, and a screwdriver, in answers A, C, and D, would not be used and, thus, are incorrect.

7. An infant weighs 7 pounds at birth. The expected weight by 1 year should be:

A. 10 pounds

B. 12 pounds

C. 18 pounds

D. 21 pounds

Answer D: A birth weight of 7 pounds would indicate 21 pounds in 1 year, or triple his birth weight. Answers A, B, and C therefore are incorrect.

8. A client is admitted with a Ewing’s sarcoma. Which symptoms would be expected due to this tumor’s location?

A. Hemiplegia

B. Aphasia

C. Nausea

D. Bone pain

Answer D: Sarcoma is a type of bone cancer; therefore, bone pain would be expected. Answers A, B, and C are not specific to this type of cancer and are incorrect.

9. The nurse is caring for a client with epilepsy who is being treated with carbamazepine (Tegretol). Which laboratory value might indicate a serious side effect of this drug?

A. Uric acid of 5mg/dL

B. Hematocrit of 33%

C. WBC 2,000 per cubic millimeter

D. Platelets 150,000 per cubic millimeter

Answer C: Tegretol can suppress the bone marrow and decrease the white blood cell count; thus, a lab value of WBC 2,000 per cubic millimeter indicates side effects of the drug. Answers A and D are within normal limits, and answer B is a lower limit of normal; therefore, answers A, B, and D are incorrect.

10. A 6-month-old client is admitted with possible intussuception. Which question during the nursing history is least helpful in obtaining information regarding this diagnosis?

A. Tell me about his pain.

B. What does his vomit look like?

C. Describe his usual diet.

D. Have you noticed changes in his abdominal size?

Answer C: The least-helpful questions are those describing his usual diet. A, B, and D are useful in determining the extent of disease process and, thus, are incorrect.

11. The nurse is assisting a client with diverticulosis to select appropriate foods. Which food should be avoided?

A. Bran

B. Fresh peaches

C. Cucumber salad

D. Yeast rolls

Answer C: The client with diverticulitis should avoid foods with seeds. The foods in answers A, B, and D are allowed; in fact, bran cereal and fruit will help prevent constipation.

12. A client has rectal cancer and is scheduled for an abdominal perineal resection. What should be the priority nursing care during the post-op period?

A. Teaching how to irrigate the illeostomy

B. Stopping electrolyte loss in the incisional area

C. Encouraging a high-fiber diet

D. Facilitating perineal wound drainage

Answer D: The client with a perineal resection will have a perineal incision. Drains will be used to facilitate wound drainage. This will help prevent infection of the surgical site. The client will not have an illeostomy, as in answer A; he will have some electrolyte loss, but treatment is not focused on preventing the loss, so answer B is incorrect. A high-fiber diet, in answer C, is not ordered at this time.

13. The nurse is performing discharge teaching on a client with diverticulitis who has been placed on a low-roughage diet. Which food would have to be eliminated from this client’s diet?

A. Roasted chicken

B. Noodles

C. Cooked broccoli

D. Custard

Answer C: The client with diverticulitis should avoid eating foods that are gas forming and that increase abdominal discomfort, such as cooked broccoli. Foods such as those listed in answers A, B, and D are allowed.

14. The nurse is caring for a new mother. The mother asks why her baby has lost weight since he was born. The best explanation of the weight loss is:

A. The baby is dehydrated due to polyuria.

B. The baby is hypoglycemic due to lack of glucose.

C. The baby is allergic to the formula the mother is giving him.

D. The baby can lose up to 10% of weight due to meconium stool, loss of extracellular fluid, and initiation of breast-feeding.

Answer D: After birth, meconium stool, loss of extracellular fluid, and initiation of breastfeeding cause the infant to lose body mass. There is no evidence to indicate dehydration, hypoglycemia, or allergy to the infant formula; thus, answers A, B, and C are incorrect.

15. The nurse is caring for a client with laryngeal cancer. Which finding ascertained in the health history would not be common for this diagnosis?

A. Foul breath

B. Dysphagia

C. Diarrhea

D. Chronic hiccups

Answer C: Diarrhea is not common in clients with mouth and throat cancer. All the findings in answers A, B, and D are expected findings.

16. A removal of the left lower lobe of the lung is performed on a client with lung cancer. Which post-operative measure would usually be included in the plan?

A. Closed chest drainage

B. A tracheostomy

C. A mediastinal tube

D. Percussion vibration and drainage

Answer A: The client with a lung resection will have chest tubes and a drainage-collection device. He probably will not have a tracheostomy or mediastinal tube, and he will not have an order for percussion, vibration, or drainage. Therefore, answers B, C, and D are incorrect.

17. Six hours after birth, the infant is found to have an area of swelling over the right parietal area that does not cross the suture line. The nurse should chart this finding as:

A. A cephalohematoma

B. Molding

C. Subdural hematoma

D. Caput succedaneum

Answer A: A swelling over the right parietal area is a cephalohematoma, an area of bleeding outside the cranium. This type of hematoma does not cross the suture line because it is outside the cranium but beneath the periosteum. Answer B, molding, is overlapping of the bones of the cranium and, thus, incorrect. In answer C, a subdural hematoma, or intracranial bleeding, is ominous and can be seen only on a CAT scan or x-ray. A caput succedaneum, in answer D, crosses the suture line and is edema.

18. The nurse is assisting the RN with discharge instructions for a client with an implantable defibrillator. What discharge instruction is essential?

A. You cannot eat food prepared in a microwave.

B. You should avoid moving the shoulder on the side of the pacemaker site for 6 weeks.

C. You should use your cellphone on your right side.

D. You will not be able to fly on a commercial airliner with the defibrillator in place.

Answer C: The client with an internal defibrillator should learn to use any battery-operated machinery on the opposite side. He should also take his pulse rate and report dizziness or fainting. Answers A, B, and D are incorrect because the client can eat food prepared in the microwave, move his shoulder on the affected side, and fly in an airplane.

19. A client in the cardiac step-down unit requires suctioning for excess mucous secretions. The nurse should be most careful to monitor the client for which dysrhythmia during this procedure?

A. Bradycardia

B. Tachycardia

C. Premature ventricular beats

D. Heart block

Answer A: Suctioning can cause a vagal response and bradycardia. Answer B is unlikely and, therefore, not most important, although it can occur. Answers C and D can occur as well, but they are less likely.

20. The nurse is caring for a client scheduled for a surgical repair of a sacular abdominal aortic aneurysm. Which assessment is most crucial during the preoperative period?

A. Assessment of the client’s level of anxiety

B. Evaluation of the client’s exercise tolerance

C. Identification of peripheral pulses

D. Assessment of bowel sounds and activity

Answer C: The assessment that is most crucial to the client is the identification of peripheral pulses because the aorta is clamped during surgery. This decreases blood circulation to the kidneys and lower extremities. The nurse must also assess for the return of circulation to the lower extremities. Answer A is of lesser concern, answer B is not advised at this time, and answer D is of lesser concern than answer A.

21. A client with suspected renal disease is to undergo a renal biopsy. The nurse plans to include which statement in the teaching session?

A. You will be sitting for the examination procedure.

B. Portions of the procedure will cause pain or discomfort.

C. You will be given some medication to anesthetize the area.

D. You will not be able to drink fluids for 24 hours before the study.

Answer B: Portions of the exam are painful, especially when the sample is being withdrawn, so this should be included in the session with the client. Answer A is incorrect because the client will be positioned prone, not in a sitting position, for the exam. Anesthesia is not commonly given before this test, making answer C incorrect. Answer D is incorrect because the client can eat and drink following the test.

22. The nurse is performing an assessment on a client with possible pernicious anemia. Which data would support this diagnosis?

A. A weight loss of 10 pounds in 2 weeks

B. Complaints of numbness and tingling in the extremities

C. A red, beefy tongue

D. A hemoglobin level of 12.0gm/dL

Answer C: A red, beefy tongue is characteristic of the client with pernicious anemia. Answer A, a weight loss of 10 pounds in 2 weeks, is abnormal but is not seen in pernicious anemia. Numbness and tingling, in answer B, can be associated with anemia but are not particular to pernicious anemia. This is more likely associated with peripheral vascular diseases involving vasculature. In answer D, the hemoglobin is low normal.

23. A client arrives in the emergency room with a possible fractured femur. The nurse should anticipate an order for:

A. Trendelenburg position

B. Ice to the entire extremity

C. Buck’s traction

D. An abduction pillow

Answer C: The client with a fractured femur will be placed in Buck’s traction to realign the leg and to decrease spasms and pain. The Trendelenburg position is the wrong position for this client, so answer A is incorrect. Ice might be ordered after repair, but not for the entire extremity, so answer B is incorrect. An abduction pillow is ordered after a total hip replacement, not for a fractured femur; therefore, answer D is incorrect.

24. A client with cancer is to undergo an intravenous pyelogram. The nurse should:

A. Force fluids 24 hours before the procedure

B. Ask the client to void immediately before the study

C. Hold medication that affects the central nervous system for 12 hours pre- and post-test

D. Cover the client’s reproductive organs with an x-ray shield

Answer B: The client having an intravenous pyelogram will have orders for laxatives or enemas, so asking the client to void before the test is in order. A full bladder or bowel can obscure the visualization of the kidney ureters and urethra. In answers A, C, and D, there is no need to force fluids before the procedure, to withhold medications, or to cover the reproductive organs.

25. The nurse is caring for a client with a malignancy. The classification of the primary tumor is Tis. The nurse should plan care for a tumor:

A. That cannot be assessed

B. That is in situ

C. With increasing lymph node involvement

D. With distant metastasis

Answer B: Cancer in situ means that the cancer is still localized to the primary site. Cancer is graded in terms of tumor, grade, node involvement, and mestatasis. Answer A is incorrect because it is an untrue statement. Answer C is incorrect because T indicates tumor, not node involvement. Answer D is incorrect because a tumor that is in situ is not metastasized.

26. A client is 2 days post-operative colon resection. After a coughing episode, the client’s wound eviscerates. Which nursing action is most appropriate?

A. Reinsert the protruding organ and cover with 4×4s

B. Cover the wound with a sterile 4×4 and ABD dressing

C. Cover the wound with a sterile saline-soaked dressing

D. Apply an abdominal binder and manual pressure to the wound

Answer C: If the client eviscerates, the abdominal content should be covered with a sterile saline-soaked dressing. Reinserting the content should not be the action and will require that the client return to surgery; thus, answer A is incorrect. Answers B and D are incorrect because they are not appropriate to this case.

27. The nurse is preparing a client for surgery. Which item is most important to remove before sending the client to surgery?

A. Hearing aid

B. Contact lenses

C. Wedding ring

D. Artificial eye

Answer B: It is most important to remove the contact lenses because leaving them in can lead to corneal drying, particularly with contact lenses that are not extended-wear lenses. Leaving in the hearing aid or artificial eye will not harm the client. Leaving the wedding ring on is also allowed; usually, the ring is covered with tape. Therefore, answers A, C, and D are incorrect.

28. The nurse on the 3–11 shift is assessing the chart of a client with an abdominal aneurysm scheduled for surgery in the morning and finds that the consent form has been signed, but the client is unclear about the surgery and possible complications. Which is the most appropriate action?

A. Call the surgeon and ask him or her to see the client to clarify the information

B. Explain the procedure and complications to the client

C. Check in the physician’s progress notes to see if understanding has been documented

D. Check with the client’s family to see if they understand the procedure fully

Answer A: It is the responsibility of the physician to explain and clarify the procedure to the client. Answers B, C, and D are incorrect because they are not within the nurse’s purview.

29. When assessing a client for risk of hyperphosphatemia, which piece of information is most important for the nurse to obtain?

A. A history of radiation treatment in the neck region

B. A history of recent orthopedic surgery

C. A history of minimal physical activity

D. A history of the client’s food intake

Answer A: Previous radiation to the neck might have damaged the parathyroid glands, which are located on the thyroid gland, and interfered with calcium and phosphorus regulation. Answer B has no significance to this case; answers C and D are more related to calcium only, not to phosphorus regulation.

30. A client is admitted to the acute care unit. Initial laboratory values reveal serum sodium of 170meq/L. What behavior changes would be most common for this client?

A. Anger

B. Mania

C. Depression

D. Psychosis

Answer B: The client with serum sodium of 170meq/L has hypernatremia and might exhibit manic behavior. Answers A, C, and D are not associated with hypernatremia and are, therefore, incorrect.

31. The nurse is obtaining a history of an 80-year-old client. Which statement made by the client might indicate a possible fluid and electrolyte imbalance?

A. My skin is always so dry.

B. I often use a laxative for constipation.

C. I have always liked to drink a lot of ice tea.

D. I sometimes have a problem with dribbling urine.

Answer B: Frequent use of laxatives can lead to diarrhea and electrolyte loss. Answers A, C, and D are not of particular significance in this case and, therefore, are incorrect.

32. A client visits the clinic after the death of a parent. Which statement made by the client’s sister signifies abnormal grieving?

A. My sister still has episodes of crying, and it’s been 3 months since Daddy died.

B. Sally seems to have forgotten the bad things that Daddy did in his lifetime.

C. She really had a hard time after Daddy’s funeral. She said that she had a sense of longing.

D. Sally has not been sad at all by Daddy’s death. She acts like nothing has happened.

Answer D: Abnormal grieving is exhibited by a lack of feeling sad; if the client’s sister appears not to grieve, it might be abnormal grieving. This family member might be suppressing feelings of grief. Answers A, B, and C are all normal expressions of grief and, therefore, incorrect.

33. The nurse recognizes that which of the following would be most appropriate to wear when providing direct care to a client with a cough?

A. Mask

B. Gown

C. Gloves

D. Shoe covers

Answer A: If the nurse is exposed to the client with a cough, the best item to wear is a mask. If the answer had included a mask, gloves, and a gown, all would be appropriate, but in this case, only one item is listed; therefore, answers B and C are incorrect. Shoe covers are not necessary, so answer D is incorrect.

34. The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention?

A. Suggest that the client take warm showers B.I.D.

B. Add baby oil to the client’s bath water

C. Apply powder to the client’s skin

D. Suggest a hot-water rinse after bathing

Answer B: Oils can be applied to help with the dry skin and to decrease itching, so adding baby oil to bath water is soothing to the skin. Answer A is incorrect because bathing twice a day is too frequent and can cause more dryness. Answer C is incorrect because powder is also drying. Rinsing with hot water, as stated in answer D, dries out the skin as well.

35. A client with pancreatitis has been transferred to the intensive care unit. Which order would the nurse anticipate?

A. Blood pressure every 15 minutes

B. Insertion of a Levine tube

C. Cardiac monitoring

D. Dressing changes two times per day

Answer B: The client with pancreatitis frequently has nausea and vomiting. Lavage is often used to decompress the stomach and rest the bowel, so the insertion of a Levine tube should be anticipated. Answers A and C are incorrect because blood pressures are not required every 15 minutes, and cardiac monitoring might be needed, but this is individualized to the client. Answer D is incorrect because