NCLEX

NCLEX Select All That Apply Practice Exam 11

A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply:

Please select 3 correct answers

Chronic stress

Severe anxiety

Generalized pain

Excessive caffeine

Chronic depression

Environmental noise

Correct! Wrong!

Acute or primary insomnia is caused by emotional or physical discomfort not caused by the direct physiologic effects of a substance or a medical condition. Excessive caffeine intake is an example of disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and/or emotional and therefore is related to primary insomnia.

Select all that apply to the use of barbiturates in treating insomnia:

Please select 3 correct answers

Barbiturates deprive people of NREM sleep

Barbiturates deprive people of REM sleep

When the barbiturates are discontinued, the NREM sleep increases

When the barbiturates are discontinued, the REM sleep increases

Nightmares are often an adverse effect when discontinuing barbiturates

Correct! Wrong!

Barbiturates deprive people of REM sleep. When the barbiturate is stopped and REM sleep once again occurs, a rebound phenomenon occurs. During this phenomenon, the persons dream time constitutes a larger percentage of the total sleep pattern, and the dreams are often nightmares.

Select all that apply that is appropriate when there is a benzodiazepine overdose:

Please select 3 correct answers

Administration of syrup of ipecac

Gastric lavage

Activated charcoal and a saline cathartic

Hemodialysis

Administration of Flumazenil

Correct! Wrong!

If ingestion is recent, decontamination of the GI system is indicated. The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Gastric lavage is generally the best and most effective means of gastric decontamination. Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Hemodialysis is not useful in the treatment of benzodiazepine overdose. Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation.

A nurse has reinforced instructions to the client with hyperparathyroidism regarding home care measures related to exercise. Which statement by the client indicates a need for further instruction? Select all that apply.

Please select 2 correct answers

"I enjoy exercising but I need to be careful."

"I need to pace my activities throughout the day."

"I need to limit playing football to only the weekends."

"I should gauge my activity level by my energy level."

"I should exercise in the evening to encourage a good sleep pattern."

Correct! Wrong!

The client should be instructed to avoid high-impact activity or contact sports such as football. Exercising late in the evening may interfere with restful sleep. The client with hyperparathyroidism should pace activities throughout the day and plan for periods of uninterrupted rest. The client should plan for at least 30 minutes of walking each day to support calcium movement into the bones. The client should be instructed to use energy level as a guide to activity.

A nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects pulmonary edema. The nurse immediately notifies the registered nurse and expects which interventions to be prescribed? Select all that apply.

Please select 4 correct answers

Administering oxygen

Inserting a Foley catheter

Administering furosemide (Lasix)

Administering morphine sulfate intravenously

Transporting the client to the coronary care unit

Placing the client in a low Fowler's side-lying position

Correct! Wrong!

Pulmonary edema is a life-threatening event that can result from severe heart failure. In pulmonary edema the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high Fowler's position to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to accurately measure output. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and reduces the work of breathing. Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be necessary at all if the client's response to treatment is successful

The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular implant. Which home care measures will the nurse include in the plan? Select all that apply.

Please select 4 correct answers

To avoid activities that require bending over

To contact the surgeon if eye scratchiness occurs

To place an eye shield on the surgical eye at bedtime

That episodes of sudden severe pain in the eye is expected

To contact the surgeon if a decrease in visual acuity occurs

To take acetaminophen (Tylenol) for minor eye discomfort

Correct! Wrong!

After eye surgery, some scratchiness and mild eye discomfort may occur in the operative eye and is usually relieved by mild analgesics. If the eye pain becomes severe, the client should notify the surgeon because this may indicate hemorrhage, infection, or increased intraocular pressure. The nurse would also instruct the client to notify the surgeon of purulent drainage, increased redness, or any decrease in visual acuity. The client is instructed to place an eye shield over the operative eye at bedtime to protect the eye from injury during sleep and to avoid activities that increase intraocular pressure such as bending over.

The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular implant. Which home care measures will the nurse include in the plan? Select all that apply.

Please select 3 correct answers

To avoid activities that require bending over

To contact the surgeon if eye scratchiness occurs

To place an eye shield on the surgical eye at bedtime

That episodes of sudden severe pain in the eye is expected

To take acetaminophen (Tylenol) for minor eye discomfort

Correct! Wrong!

When the nurse is collecting data from the older adult, which of the following findings would be considered normal physiological changes? Select all that apply.

Please select 3 correct answers

Increased heart rate

Decline in visual acuity

Decreased respiratory rate

Decline in long-term memory

Increased susceptibility to urinary tract infections

Increased incidence of awakening after sleep onset

Correct! Wrong!

Anatomical changes to the eye affect the individual's visual ability, which leads to potential problems with activities of daily living. Light adaptation and visual fields are reduced. Respiratory rates are usually unchanged. The heart rate decreases, and the heart valves thicken. Age-related changes that affect the urinary tract increase an older client's susceptibility to urinary tract infections. Short-term memory may decline with age, but long-term memory is usually maintained. Changes in sleep patterns are consistent, age-related changes. Older persons experience an increased incidence of awakening after sleep onset.

Which data indicates to the nurse that a client may be experiencing ineffective coping?

Constantly neglects personal grooming

Visits her husband's grave once a month

Visits the senior citizens' center once a month

Frequently looks at snapshots of her husband and family

Correct! Wrong!

Coping mechanisms are behaviors that are used to decreased stress and anxiety. In response to a death, ineffective coping is manifested by an extreme behavior that in some instances may be harmful to the individual, physically, psychologically, or both. Option 1 is indicative of a behavior that identifies an ineffective coping behavior as part of the grieving process. The remaining options identify effective coping behaviors.

The mother of a child with cystic fibrosis tells the nurse that her child makes “snoring” sounds when breathing. The nurse is aware that many children with cystic fibrosis have:

Choanal atresia

Nasal polyps

Septal deviations

Enlarged adenoids

Correct! Wrong!

Children with cystic fibrosis are susceptible to chronic sinusitis and nasal polyps, which might require surgical removal. Answer A is incorrect because it is a congenital condition in which there is a bony obstruction between the nares and the pharynx. Answers C and D are not specific to the child with cystic fibrosis; therefore, they are incorrect.

A client is hospitalized with hepatitis A. Which of the client’s regular medications is contraindicated due to the current illness?

Prilosec (omeprazole)

Synthroid (levothyroxine)

Premarin (conjugated estrogens)

Lipitor (atorvastatin)

Correct! Wrong!

Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.

The nurse has been teaching the role of diet in regulating blood pressure to a client with hypertension. Which meal selection indicates that the client understands his new diet?

Cornflakes, whole milk, banana, and coffee

Scrambled eggs, bacon, toast, and coffee

Oatmeal, apple juice, dry toast, and coffee

Pancakes, ham, tomato juice, and coffee

Correct! Wrong!

Oatmeal is low in sodium and high in fiber. Limiting sodium intake and increasing fiber helps to lower cholesterol levels, which reduce blood pressure. Answer A is incorrect because cornflakes and whole milk are higher in sodium and are poor sources of fiber. Answers B and D are incorrect because they contain animal proteins that are high in both cholesterol and sodium.

An 18-month-old is being discharged following hypospadias repair. Which instruction should be included in the nurse’s discharge teaching?

The child should not play on his rocking horse.

Applying warm compresses to decrease pain.

Diapering should be avoided for 1–2 weeks.

The child will need a special diet to promote healing.

Correct! Wrong!

The child will need to avoid straddle toys, swimming, and rough play until allowed by the surgeon. Answers B, C, and D do not relate to the post-operative care of the child with hypospadias; therefore, they are incorrect.

An obstetrical client calls the clinic with complaints of morning sickness. The nurse should tell the client to:

Keep crackers at the bedside for eating before she arises

Drink a glass of whole milk before going to sleep at night

Skip breakfast but eat a larger lunch and dinner

rink a glass of orange juice after adding a couple of teaspoons of sugar

Correct! Wrong!

Eating a carbohydrate source such as dry crackers or toast before arising helps alleviate symptoms of morning sickness. Answer B is incorrect because the additional fat might increase the client’s nausea. Answer C is incorrect because the client does not need to skip meals. Answer D is the treatment of hypoglycemia, not morning sickness; therefore, it is incorrect.

The nurse has taken the blood pressure of a client hospitalized with methicillin-resistant staphylococcus aureus. Which action by the nurse indicates an understanding regarding the care of clients with MRSA?

The nurse leaves the stethoscope in the client’s room for future use.

The nurse cleans the stethoscope with alcohol and returns it to the exam room.

The nurse uses the stethoscope to assess the blood pressure of other assigned clients.

The nurse cleans the stethoscope with water, dries it, and returns it to the nurse’s station.

Correct! Wrong!

The stethoscope should be left in the client’s room for future use. The stethoscope should not be returned to the exam room or the nurse’s station; therefore, answers B and D are incorrect. The stethoscope should not be used to assess other clients; therefore, answer C is incorrect.

The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism. The nurse can reinforce the physician’s teaching by telling the parents that:

The medication will be needed only during times of rapid growth.

The medication will be needed throughout the child’s lifetime.

The medication schedule can be arranged to allow for drug holidays.

The medication is given one time daily every other day.

Correct! Wrong!

The medication will be needed throughout the child’s lifetime. Answers A, C, and D contain inaccurate statements; therefore, they are incorrect.

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NCLEX Select All That Apply Practice Exam 11

A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply:

Select all that apply to the use of barbiturates in treating insomnia:

Select all that apply that is appropriate when there is a benzodiazepine overdose:

A nurse has reinforced instructions to the client with hyperparathyroidism regarding home care measures related to exercise. Which statement by the client indicates a need for further instruction? Select all that apply.

The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular implant. Which home care measures will the nurse include in the plan? Select all that apply.

The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular implant. Which home care measures will the nurse include in the plan? Select all that apply.

When the nurse is collecting data from the older adult, which of the following findings would be considered normal physiological changes? Select all that apply.

Which data indicates to the nurse that a client may be experiencing ineffective coping?

The mother of a child with cystic fibrosis tells the nurse that her child makes “snoring” sounds when breathing. The nurse is aware that many children with cystic fibrosis have:

A client is hospitalized with hepatitis A. Which of the client’s regular medications is contraindicated due to the current illness?

The nurse has been teaching the role of diet in regulating blood pressure to a client with hypertension. Which meal selection indicates that the client understands his new diet?

An 18-month-old is being discharged following hypospadias repair. Which instruction should be included in the nurse’s discharge teaching?

An obstetrical client calls the clinic with complaints of morning sickness. The nurse should tell the client to:

The nurse has taken the blood pressure of a client hospitalized with methicillin-resistant staphylococcus aureus. Which action by the nurse indicates an understanding regarding the care of clients with MRSA?

The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism. The nurse can reinforce the physician’s teaching by telling the parents that:

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