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NCLEX-RN REVIEW QUESTIONS AND ANSWERS 2022

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NCLEX-RN REVIEW QUESTIONS AND ANSWERS 2022 A parent of a 14 month-old is sharing concerns with the nurse. Which statement by a parent would alert a nurse to assess for iron-deficiency anemia in t... he toddler? "My child doesn't like many fruits and vegetables, but really loves milk." "I can't understand why my child is not eating as much as four months ago." "My child doesn't drink a whole glass of juice or water at one time." "I know there is a problem since my baby is always constipated." - ANS-About two to three cups of milk a day are sufficient for the young child's needs. Sometimes excess milk intake, a habit carried over from infancy, may exclude many solid foods from the diet. As a result, the child may lack iron and develop a so-called milk anemia. Although the majority of infants with iron deficiency are underweight, many are overweight because of excessive milk ingestion. A nurse is teaching about nonsteroidal anti-inflammatory agents (NSAIDs) to a group of clients diagnosed with arthritis. The nurse should emphasize which of these actions to minimize a side effect of these drugs? Continue to take aspirin for short-term pain relief Use alcohol in moderation when driving or operating heavy machinery Take the medication after meals or with food Report joint stiffness in the morning - ANS-Taking NSAIDs after meals or with food should help to minimize gastric irritation. The client should also take the medication with a full glass of water and remain in an upright position for 15 to 30 minutes after administration. Clients should be cautioned to avoid concurrent use of aspirin or alcohol with these medications to minimize possible gastric irritation; three or more glasses of alcohol per day may increase the risk of GI bleeding. The clinic nurse is counseling a postpartum client who has a substance-abuse problem and is at risk for continued cocaine use. In order to provide continuity of care, which nursing diagnosis should be a priority? Altered parenting Social isolation Ineffective coping Sexual dysfunction - ANS-Altered parenting The mother who abuses cocaine puts her newborn and any other children at risk for neglect and abuse. The continued use of drugs has the potential to impact parenting behaviors. Social service referrals are indicated for evaluation and follow-up. The clinic nurse is assisting with medical billing. The nurse uses the DRG (Diagnosis Related Group) manual for which purpose? a. Determine reimbursement for a medical diagnosis b. Identify findings related to a medical diagnosis c. Classify nursing diagnoses from the client's health history d. Implement nursing care based on case management protocol - ANS-a. Determine reimbursement for a medical diagnosis DRGs are the basis of prospective payment plans for reimbursement for Medicare clients. Other insurance companies often use it as a standard for determining payment. The nurse is caring for a client who is experiencing frightening hallucinations that are markedly increased at night. The client's partner asks to stay a few hours beyond the visiting time, in the client's private room. What would be the best response by the nurse? a."Yes, staying with the client and orienting the client to the surroundings may decrease any anxiety." b."No, your presence may cause the client to become more anxious." c. "No, it would be best if you brought the client some reading material that the client could read at night." d. "Yes, would you like to spend the night when the client's behavior indicates that the client is or will be frightened?" - ANS-A."Yes, staying with the client and orienting the client to the surroundings may decrease any anxiety." Encouragement of a family member or a close friend to stay with the client in a quiet surrounding cannot only help increase orientation, but can also minimize confusion and anxiety. The visitor could also report to the nurse any unusual findings of the client. This would be the most supportive approach for this client. A client diagnosed with angina has been instructed about the use of sublingual nitroglycerin. Which statement made by the client is incorrect and indicates a need for further teaching? a. "I'll call the health care provider if pain continues after three tablets five minutes apart." b. "I will rest briefly right after taking one tablet." c. "I understand that the medication should be kept in the dark bottle." d. "I can swallow two or three tablets at once if I have severe pain." - ANS-d. "I can swallow two or three tablets at once if I have severe pain." Clients must understand that just one sublingual tablet should be taken at a time and placed under the tongue. After rest and a five-minute interval, a second and then eventually a third tablet may be necessary. The nurse is caring for a school-aged child with a diagnosis of secondary hyperparathyroidism after treatment for chronic renal disease. Which serum lab data should receive priority attention by the nurse? a. Osmolality and sodium b. Blood urea nitrogen and magnesium c. Calcium and phosphorus d. Glucose and potassium - ANS-c. Calcium and phosphorus The parathyroid regulates the calcium and phosphorus serum levels. Calcium and phosphorous levels will be elevated in hyperfunction of this gland until the client is stabilized. To recall this information think of a see-saw. Associate that calcium is first in the alphabet and thus calcium follows the direction of the abnormality - hyper or hypo function - of the parathyroid. Put the calcium on one side and the phosphorus on the other side of the see-saw. The nurse is providing preprocedural education to the client preparing for a barium enema. What statement made by the client indicates a need for further education? a. "I will need to drink plenty of fluids and eat foods high in fiber after the procedure." b. "I will use the prescribed laxative before the procedure." c. "I will not eat or drink anything after midnight before the procedure." d. "A barium enema is used to examine the upper and lower GI tracts." - ANS-d. "A barium enema is used to examine the upper and lower GI tracts." A barium enema involves filling the large intestine (lower GI tract) with diluted barium liquid while x-ray images are taken. After the procedure, a small amount of barium will be immediately expelled and the remainder will be excreted in the stool. Because barium liquid may cause constipation, clients should eat foods high in fiber and drink plenty of fluids to help expel the barium from the body. The nurse is working with victims of domestic abuse. The nurse should understand which of these factors is a reason why domestic violence or emotional abuse remains extensively undetected? a. The expenses due to police and court costs are prohibitive b. Little knowledge is known about batterers and battering relationships c. There are typically many series of minor, vague complain d. Few people who have been battered seek medical care - ANS-c. There are typically many series of minor, vague complain Signs of domestic violence or emotional abuse may not be clearly manifested and include many series of a minor complaints such as headache, abdominal pain, insomnia, back pain and dizziness. These may be covert indications of violence or abuse that go undetected. These complaints may be vague and reflect ambivalence about the disclosure of any violence or abuse. An 18 month-old weighing 22 pounds is admitted to the pediatric unit with a diagnosis of dehydration. A replacement bolus of normal saline at 20 mL/kg is ordered to be administered intravenously over 40 minutes. In mL/hour, what will be the setting for the IV delivery system? _______mL/hr. - ANS-300mL/hr Using ratio proportion: First, convert 22 pounds to kilograms (22/2.2) = 10 kg 20 mL/kg = 20 x 10 kg = 200 mL 200 mL/40 minutes = x mL/60 minutes (in an hour) 200 x 60 = 12000/40 = 300 mL/hr Using dimensional analysis: 20 mL/kg x 1 kg/2.2 lb x 22 lb x 60 min/hr x 1/40 min = 300 mL/hr The nurse is caring for a 50 year-old client diagnosed with advanced cirrhosis of the liver. Which nursing diagnosis should take priority? a. Fluid volume excess: ascites b. Risk for injury related to peripheral neuropathy c. Altered nutrition: less than body requirements d. Risk for injury: hemorrhage - ANS-d. Risk for injury: hemorrhage Liver disease interferes with the production of prothrombin and other factors essential for blood clotting. In addition, hemorrhage, especially from esophageal varices, can be life-threatening. This takes priority over the other nursing diagnosis. The RN, who is functioning as the charge nurse, needs to determine shift assignments. How will the charge nurse determine which client assignments are appropriate for the licensed practical nurse (LPN)? a. Ask the LPN about prior experience caring for clients with similar diagnoses b. Determine how many nursing assistants are available to help the LPN with client care c. Refer to the list of technical tasks LPNs are trained to perform d. Review the procedure manual with the LPN prior to making an assignment - ANSa. Ask the LPN about prior experience caring for clients with similar diagnoses The definition of assignment is the routine care, activities and procedures that are within the authorized scope of practice of the RN or LPN/LVN. The RN must determine the needs of the clients and make assignments not only based on scope of practice, but also education, demonstrated competency and skill level. Regardless if the LPN received education and training to perform specific skills, the RN needs to determine the LPN's experience with caring for clients with similar diagnoses. While the RN is responsible for ensuring an assignment given to a delegatee is carried out completely and correctly, the LPN must be able to perform the skills or tasks independently. The nurse is caring for a client who just had a central venous catheter line inserted at the bedside. Which of these assessments requires immediate attention by the nurse? a. Pallor in the extremities b. Increased temperature by one degree c. Involuntary coughing spells d. Dyspnea at rest - ANS-d. Dyspnea at rest Complications of central catheter insertion include pneumothorax and hemothorax. Air embolism is another potential complication. Dyspnea, shallow respirations, sudden sharp chest pain that worsens with coughing or deep breathing are indications of pneumothorax. Other potential complications of central catheters may include thrombosis, local or systemic infection, or even cardiac tamponade (if the central line perforates the heart). When considering the options listed, the client who is dyspneic after central line insertion would be the greatest concern for the nurse. The mother of a 2 month-old baby calls a pediatrician's nurse two days after the first DTaP, inactivated polio vaccine (IPV), Hepatitis B and Haemophilus influenzae type B (HIB) immunizations. She reports that the baby feels very warm, cries inconsolably for as long as three hours, and has had several shaking spells. Which immunization would the nurse expect to be primarily responsible with these findings? a. DTaP b. IPV c. Hepatitis B d. HIB - ANS-a. DTaP DTaP immunization is a vaccine that protects against diptheria, tetanus and pertussis (whooping cough). The majority of reactions described in this question occur with the administration of the DTaP vaccination. Contraindications to giving repeat DTaP immunizations include the occurrence of severe side effects after a previous dose, as well as signs of encephalopathy within seven days of the immunization. The nurse receives a client from the post anesthesia care unit following a left femoral-popliteal bypass graft procedure. Which of the following assessments requires immediate notification of the health care provider? a. Left foot is cool to the touch b. Absent left pedal pulse using Doppler analysis c. Inability to palpate the left pedal pulse d. Acute pain in the left lower leg - ANS-Although the inability to palpate the left pedal pulse, a cool extremity, and increased pain in the left lower leg are important findings, they all require additional nursing assessment prior to contacting the health care provider. In clients without palpable pedal pulses, the next step in the assessment is to perform a Doppler analysis. The inability to locate the left pedal pulse using the Doppler analysis requires immediately notifying the health care provider. The nurse working in the intensive care unit (ICU) is told that a client is being newly admitted with a diagnosis of hyperglycemic hyperosmolar nonketotic state (HHNS). The nurse would expect which of the following clinical findings in this client? (Select all that apply.) 1. History of type 1 diabetes mellitus 2. Ketonuria 3. Metabolic acidosis 4. Severe dehydration 5. Blood glucose level of at least 600 mg/dL (33.33 mmol/L) - ANS-4. Severe dehydration 5. Blood glucose level of at least 600 mg/dL (33.33 mmol/L) The typical client with HHNS will have a plasma glucose level of 600 mg/dL (33.33 mmol/L) or greater, high serum osmolality, profound dehydration, a serum pH greater than 7.3 and some alteration in consciousness. Unlike diabetic ketoacidosis, however, there is little to no ketosis. HHNS usually presents in older clients with type 2 diabetes mellitus who have some concomitant illness (usually an infection) that leads to reduced fluid intake, or who do not adhere to their diabetic medications and diet. All clients with HHNS require hospitalization and rapid treatment to correct the profound hypovolemia and hyperglycemia characteristic of this condition. Which individual is at greatest risk for the development of hypertension? a. 40 year-old Caucasian nurse b. 60 year-old Asian-American shop owner c. 45 year-old African-American attorney d. 55 year-old Hispanic teacher - ANS-c. 45 year-old African-American attorney The incidence of hypertension is greater among African-Americans than other groups in the United States. The incidence among the Hispanic population is rising. A nurse is planning care for a 2 year-old hospitalized child. Which issue will produce the most stress at this age? a. Fear of pain b. Separation anxiety c. Loss of control d. Bodily injury - ANS-b. Separation anxiety While a toddler will experience all of the stresses, separation from parents is the major stressor. Separation anxiety peaks in the toddler years. A woman, who delivered five days ago and who had been diagnosed with pregnancy induced hypertension (PIH), calls a hospital triage nurse hotline to ask for advice. She states, "I have had the worst headache for the past two days. It pounds and by the middle of the afternoon everything I look at looks wavy. Nothing I have taken helps." What should the nurse do next? a. Advise the client to have someone bring her to the emergency room as soon as possible b. Ask the client to explain what she has taken and how often, and then evaluate other specific complaints c. Advise the client that the swings in her hormones may be the problem; suggest that she call her health care provider d. Ask the client to stay on the line, get the address, and send an ambulance to the home - ANS-d. Ask the client to stay on the line, get the address, and send an ambulance to the home The woman is at risk for seizure activity. The ambulance needs to bring the woman to the hospital for evaluation and treatment. For at-risk clients, PIH may progress to preeclampsia and eclampsia prior to, during, or after delivery; this may occur up to 10 days after delivery. The client is admitted to an ambulatory surgery center and undergoes a right inguinal orchiectomy. Which option is the priority before the client can be discharged to home? a. Able to tolerate a regular diet b. Post-operative pain is managed c. Psychological counseling is scheduled d. Able to ambulate in the hallway with assistance - ANS-b. Post-operative pain is managed An orchiectomy is the surgical removal of one or both testicles. It is usually performed to treat cancer (testicular, prostate or cancer of the male breast), but it may also be performed to prevent cancer (with an undescended testicle.) Due to the location of the incision, pain management is the priority. Most men will be able to eat regularly when they get home; they should at least tolerate liquids before discharge. It's important that the client is able to get up and walk with assistance, but this is not the priority. Psychological counseling may be needed as part of long-term aftercare, but this is not an immediate priority. A client expresses anger when a call light is not answered within five minutes. The client demanded a blanket. How should the nurse respond? a. "I see this is frustrating for you. I have a few minutes so let's talk." b. "I am surprised that you are upset. The request could have waited a few more minutes." c. "Let's talk. Why are you upset about this?" d. "I apologize for the delay. I was involved in an emergency." - ANS-a. "I see this is frustrating for you. I have a few minutes so let's talk." This is the best response because it gives credence to the client's feelings and then concerns. To say "let's talk" and ask a why question is not a therapeutic approach because it does not acknowledge or validate the client's feelings. To apologize and not notice the client's feelings is inappropriate. To say it could have waited a few minutes is rude and non-accepting of the client's verbalized needs. The nurse is reviewing the laboratory results for several clients. Which of the laboratory result indicates a client with partly compensated metabolic acidosis? CONTINUES... [Show More]

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