NCLEX Practice Questions Blue
Need to run through a few NCLEX practice questions? Take the test and see how you do! Whether you’re practicing for the real thing or just brushing up on your knowledge, these NCLEX test questions will keep you sharp.
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A patient is ordered metformin 1000mg twice a day for his diabetes. While talking with the patient he states “I never eat breakfast so I take a ½ tablet at lunch and a whole tablet at supper because I don’t want my blood sugar to drop.” As his primary care nurse you:
Tell him he has made a good decision and to continue
Tell him to take a whole tablet with lunch and with supper
Tell him to skip the morning dose and just take the dose at supper
Tell him to take one tablet in the morning and one tablet in the evening as ordered
Question 1 Explanation:
D. The patient should take the metformin as ordered. Metformin does not cause low blood sugars due to the way it is metabolized.
A patient calls his primary care physicians office requesting an appointment. While talking with the patient he reports that about 5 weeks ago he experienced a TIA. He reports that he was discharged from the hospital with plavix 75mg. He states he took one tablet daily as prescribed and completed all 30 tablets. You do the following:
Schedule the patient ASAP to resume plavix
Inform the patient that a 30 day course of plavix is the usual course of treatment post TIA
Schedule the patient for a 6 month follow up appointment
Advise the patient that no follow up is needed unless he is having a problem
Question 2 Explanation:
A. Plavix is an anti- platelet that is needed in order to prevent further TIAs or CVA and should be continued.
A patient presents with a 2 week history of progressive increase in SOB with activity, increase in chest congestion and episodes of sweating so much that his shirt is soaked. He reports a productive cough of large amounts of green sputum. Upon assessment: T=98.2, P=110, R=24, B/P=138/70, POX=85% on RA. Lungs with inspiratory and expiratory wheezes. He appears to be in no distress. You anticipate the following orders:
PO antibiotics and discharge to home
Breathing treatment, CXR, IV antibiotic, oxygen, hospital admission
Prepare for intubation or BiPap
Home oxygen order
Question 3 Explanation:
B. The patient is exhibiting signs of a respiratory infection such as pneumonia or exacerbation of COPD. The episodes of sweating indicate fever.
A patient presents with complaints of generally not feeling well for 2 weeks, fatigue and occasional dizziness. The patient is placed on a cardiac monitor which shows a regular ventricular rate of 33 and more P waves than QRS complexes that do not seem to be associated. The patient is most likely experiencing:
1st degree heart block
3rd degree heart block
Question 4 Explanation:
C. In 3rd degree heart block there are more P waves than QRS complexes and there is no association between the P waves (atrial contraction) and QRS complexes (ventricular contraction).
A patient presents for a 2 week blood pressure check after his metoprolol tartrate was increased to 50 mg in the morning and 25mg in the evening. The patient’s blood pressure is 150/78. He denies any signs of hypertension. Prior to the patient having any further adjustments in his medication what additional information is needed?
Orhtostatic blood pressures
Question 5 Explanation:
B. Metoprolol slows the heart rate and any further increase could not be made if the patient’s heart rate is low.
A patient presents requesting a nicotine replacement patch for smoking cessation. He reports that he is a long time smoker of 1 pack per day and that he is usually up once a night to smoke a cigarette. Based on this information the patient:
Can quit cold turkey without any problems
Requires a low dose patch
Has a high level of nicotine addiction
Will not be able to stop smoking
Question 6 Explanation:
C. A patient waking up at night for a cigarette indicates a higher level of addiction to nicotine.
A patient with COPD is given a Z-Pak for an exacerbation. He has an albuterol inhaler (MDI) at home ordered as 2 puffs 4 times a day as needed. The patient was instructed to use his MDI 2 puffs four times a day on schedule until he completes his antibiotic. The patient states I only use the inhaler when I go for a walk because I don’t want to get hooked on it. You reply:
You’re correct; don’t use the inhaler unless you absolutely have to use it.
You will not become addicted if you stop using the inhaler 4 times a day as soon as you’re antibiotic is done.
The inhaler is not addictive when taken with an antibiotic.
The inhaler is not addictive at all and should be used more frequently during an exacerbation of COPD.
Question 7 Explanation:
D. Albuterol is not addictive. It will help with SOB, coughing and clearing of secretions. It should be used more frequently and even on schedule during an exacerbation of COPD.
Patient presents with right sided rib pain after a fall. He complains of constant pain that is worse with deep inspiration. The CXR reveals a 5th right rib fracture. He is on 24 hour oxygen therapy and a history of asthma and chronic bronchitis. The physican orders pain medication. As a nursing measure you perform the following:
Provide the patient with an incentive spirometer and teach him to perform incentive spirometry every hour while awake.
Nothing further is needed.
Instruct the patient to take his pain medication only at night so that he can sleep.
Instruct the patient to move as little as possible to decrease pain.
Question 8 Explanation:
A. The patient has comprised lung function causing increased risk for respiratory complications. The rib fracture pain will cause the patient to take more shallow breaths. Incentive spirometry will cause the patient to take deep breaths to prevent respiratory complications such as pneumonia.
A patient presents with a one week history of dizziness, left lower quadrant abdominal discomfort and 2 or 3 three black stools. You anticipate the following orders:
Pain medication, PO antibiotics, discharge home.
Home occult blood test for the stool, increase in fluids, return in one week for re-evaluation.
CBC and CT scan to rule out diverticulitis.
Bed rest, IV fluids, admission for observation.
Question 9 Explanation:
Answer: C. Left lower quadrant pain and signs of GI bleeding may indicate diverticulitis. A CBC would assist in determining not only anemia but infection as well.
An 82 year old female is brought to the ER with new onset of confusion. She typically lives alone and is independent. She does have incontinence and wears depends. What orders do you anticipate?
CBC, U/A, IV antibiotic
CT of head
Admission for observation and neurology evaluation
New diagnosis of dementia
Question 10 Explanation:
A. In the elderly, confusion may be the only sign of a UTI. Wearing wet depends may increase the risk the UTI. The CBC will assist in determining if urosepsis is present.
The home hospice nurse visits a patient that is actively dying. The family reports that the patient has moist rattle with breathing. What medication will help the moist respirations?
Atropine eye drops sublingual
Question 11 Explanation:
C. Atropine eye drops sublingual will dry the secretions.
A patient with chronic low back pain is on extended release morphine twice a day for pain control. The patient has a pain contract in place. He requests a refill for his pain medication. Upon review of his request for pain medication refills you note that he has requested his pain medication at least 10 days later than expected the last three times. You have the patient come in to assess his use of the pain medication. He reports that he takes the pain medication once a day and he only uses the second dose if needed. What do you anticipate next?
Authorization of a refill for his medication
Instruction for use of extended release medication, review of the pain contract, decrease in dose to once a day
Discontinuation of medication
Change in the orders for one tablet of the extended release morphine daily with a second tablet daily as needed
Question 12 Explanation:
C. Extended release narcotics for chronic pain are meant to be taken on schedule and not as needed. A pain contract typically indicates that the narcotic will be taken as prescribed.
The American Nurses Association definition of nursing identifies which of the following activities that are in congruence with the Nurse Scope of Practice:
Explaining the danger involved in a surgical procedure
Discussing the risk of taking an investigational medication
Determining the amount of IV fluid replacement needed for a patient admitted after a motor vehicle accident
Contributing evidence to nursing research through nursing based studies on the effects of health policies on various cultural populations
Question 13 Explanation:
The correct answer is (d). All of the other options are not in the nurses’ scope of practice.
Among the reasons for a primary risk assessment for the development of cancer in women are all of the following EXCEPT:
Detecting a trait or characteristic of cancer can be associated with the development of cancer
Identifying the client who has started menses before age 12 as a risk factor in the development of cancer
Recognizing that living in certain areas of the United States have been found to be conclusive risk factors for developing cancer
Understanding that the discovery of a family history that includes at least one family member who has been diagnosed with cancer as a risk factor
Question 14 Explanation:
The correct answer is (c). Cancer occurrence in various parts of the USA is a risk factor due to various carcinogens, but it is by no means conclusive.
Tests commonly incorporated in the diagnostic workup of women’s cancer include all EXCEPT:
Cancer-related checkups including examinations for thyroid, skin, lymph node and ovarian cancer
Clinical breast exam (CBE), a manual breast examination performed by a trained clinician
Mammography, an x-ray allowing visualization of a the internal structure of the breast
Screening done on symptomatic clients to evaluate authenticity of disease process
Question 15 Explanation:
The correct answer is (d). Screening is done on asymptomatic clients in the diagnostic workup stage
A 38 year old female client has undergone a right modified radical mastectomy for breast cancer. Post operatively, she experiences incisional pain and swelling and limited movement of her right arm. The surgeon has informed her that four of the lymph nodes were positive for cancer and that she will have to undergo chemotherapy. As the nurse caregiver for this client, which of the following is an immediate problem related to potential health?
Impaired mobility of arm
Disturbed body image
Question 16 Explanation:
The correct answer is (a). The pain postoperatively must be evaluated and treated prior to any of the other options.
Nurses caring for the female cancer patient must be acquainted with a special perspective that focuses on the female. These perspectives include all EXCEPT:
Coping skills supporting family interactions
Emotional support regarding questions about changes in body image
Informational support regarding lifestyle changes
Decision making support regarding the type of surgery that best suites the clients cancer
Question 17 Explanation:
The correct answer is (d). Helping the client make a decision about the type of surgery she must undergo is clearly not in the nurses’ scope of practice.
Knowledge of the breasts and their functions include:
The breasts are supported by and attached to the chest wall, resting on the major scapular chest muscle
The areolas deliver milk through the opening in the nipple
Fibrosis, cysts, mastitis, contribute more than 70% added risk to developing breast cancer
The major hormones affecting the breast are estrogen, progesterone, and prolactin
Question 18 Explanation:
The correct answer is (d). The other statements are false.
Treatment of breast cancer involves many modalities. All of the answers below are correct EXCEPT:
Staging which shows the size and spread of the malignancy
Identifying the presence of the BRCA ½ factor predicting risk for optimum treatment
Performing breast-sparing surgery (lumpectomy)
incorporating chemotherapy as an adjunct to surgery
Question 19 Explanation:
The correct answer is (b). Identification of the BRCA ½ factor is used in the screening of breast cancer not in the treatment phase.
A 65 year old African American female has been diagnosed with lung cancer and is scheduled for a left thoracotomy. As the nurse caring for this client you understand that the major determining factor of this client’s health is the fact that:
She is African American and lacks health insurance
She chose to smoke all of her adult life
Her mother died of lung cancer at about the same age
She has limited ability to understand and act on health information post-operation
Question 20 Explanation:
The correct answer is (b) she chose to smoke all of her life which influences the rest of her health going forward.
Cancer can occur in the lining of the uterus, the endometrium. Women must be alert to the fact that these disorders of the endometrium can cause the same symptoms whether the disease is benign or malignant. A symptom that occurs in endometrial cancer that is different from endometriosis is:
Irregular menstrual bleeding
Lower back or pelvic pain
Vaginal bleeding between periods
Question 21 Explanation:
The correct answer is (d). The most common symptom of endometrial cancer is vaginal bleeding between periods.
A client explains to the nurse that they have been using a complementary medicine to control their cancer pain. As the caregiver to this client the nurse understands that all of the statements below regarding complimentary medicine are true EXCEPT:
Complementary and alternative medicines are in direct contract to one another
Complimentary therapies are adjuncts to conventional care
Complimentary therapies are used by cancer patients with the belief that the therapies will control pain and improve physical or emotional well-being
Complimentary medicine substitute conventional therapies
Question 22 Explanation:
The correct answer is (d). Complimentary medicinal therapies are used in conjunction with standard methods of cancer care.
A client experiences an episode of pulmonary edema because the nurse forgot to administer the morning dose of furosemide (Lasix). Which legal element can the nurse be charged with?
Question 23 Explanation:
The correct answer is C. The nurse committed an act of omission (Breach of Duty) thereby constituting an act of negligence.
Which situation necessitates the use of restraints on a client?
Insufficient staffing on the unit
The client is confused and combative
Family request to make sure client is safe
Medical evaluation and written provider orders
Question 24 Explanation:
The correct answer is D. A medical evaluation and written healthcare provider orders that are timed and dated as per agency policy is required for the use of restraints.
Which ethical principle is the nurse utilizing when supporting the decision of a client to terminate chemotherapy treatments?
Question 25 Explanation:
The correct answer is A. The ethical principle supported in this situation represents the client’s autonomy or right to make his/her own decisions.
Which element legally defines the nursing scope of practice for nursing?
Hospital standards of care
Nurse Practice Acts
Professional nursing organizations
Question 26 Explanation:
The correct answer is C. The State Practice Acts help determine the legal nursing scope of practice for nurses in each state.
In which situation should the nurse accept an assignment but complete a protest of assignment?
Floating to another unit
Question 27 Explanation:
The correct answer is B. If an assignment is to care for clients than what is reasonable, it needs to be brought to the attention of nursing manager/and or supervisor. Protest of assignment do not relief a nurse of their responsibility but the nurse is attempting to act reasonable.
Which statement would be most appropriate for the nurse to document in the client’s chart?
“The client climbed over the side rails and fell out of bed.”
“The use of restraints would have prevented the fall.”
“Upon entering the room, the client was found lying on the floor.”
“The use of a sedative would have helped kept the client in bed.”
Question 28 Explanation:
The correct answer C. The cause of the patient fall is not identified and the nurse must document the facts.
A client who is a Jehovah Witness admitted with a severe upper gastrointestinal bleed requires an immediate blood transfusion. The client’s spouse refuses the transfusion to be administered. Which nursing action should the nurse take?
Administer the ordered transfusion
Explain why the transfusion is necessary
Notify the provider immediately
Obtain a court order to administer the transfusion
Question 29 Explanation:
The correct is C. In this situation, the nurse must notify the provider immediately of the refusal to allow the spouse to be transfused.
A nurse documents vital signs without actually performing the task. Which action should the charge nurse take after discussing the situation with the nurse?
Charge the nurse with malpractice
Document the incident
Notify the board of nursing
Question 30 Explanation:
The correct answer is B. After discussing the situation with the nurse, the nurse in charge should document the incident.
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