NCLEX-PN Test #18 2

Question 1

A client with cirrhosis develops asterixis (liver flap). What does this finding indicate?

Accepted Answer

Hepatic encephalopathy from ammonia accumulation

Answer

Asterixis (flapping tremor of the extended hands) is a classic neurological sign of hepatic encephalopathy caused by elevated blood ammonia (from impaired liver detoxification). It represents toxic brain dysfunction. Treatment includes lactulose (to excrete ammonia in stool) and rifaximin (to reduce ammonia-producing gut bacteria). Protein restriction may be considered.

Question 2

A client with end-stage renal disease (ESRD) on hemodialysis reports swelling of the AV fistula arm, no bruit, and no thrill. What does the nurse suspect?

Accepted Answer

AV fistula thrombosis (clotting)

Answer

The absence of a bruit (heard with stethoscope) and thrill (felt on palpation) in an AV fistula indicates thrombosis (clotting), which is a dialysis access emergency. The provider must be notified immediately for possible thrombectomy or interventional radiology consultation. Without a functioning fistula, hemodialysis cannot be performed.

Question 3

A client with hyperthyroidism is prescribed propylthiouracil (PTU). Which laboratory result indicates treatment effectiveness?

Accepted Answer

Increasing TSH levels and normalizing free T4

Answer

PTU inhibits thyroid hormone synthesis. Effective treatment results in decreasing T3/T4 levels and rising TSH (as the pituitary responds to lower thyroid hormone by increasing TSH). Normalizing TSH and free T4 into the therapeutic range indicates successful treatment of hyperthyroidism.

Question 4

A client is admitted with acute pyelonephritis. Which clinical finding best differentiates pyelonephritis from a lower UTI (cystitis)?

Accepted Answer

Costovertebral angle (CVA) tenderness, fever, and chills

Answer

Acute pyelonephritis involves upper urinary tract (kidney) infection. CVA tenderness (flank pain at the costovertebral angle, elicited by percussion), high fever (≥38.5°C), and systemic symptoms (chills, nausea, vomiting) distinguish it from lower UTI. Lower UTI (cystitis) causes dysuria, frequency, and urgency without systemic involvement or CVA tenderness.

Question 5

A client with hypovolemia requires a fluid challenge. The PN prepares to infuse 250 mL of 0.9% NS over 15 minutes. During infusion, the client develops increasing shortness of breath and crackles at the lung bases. What is the priority action?

Accepted Answer

Stop the infusion and notify the provider — signs of fluid overload are present

Answer

New onset shortness of breath with bibasilar crackles during IV fluid administration indicates pulmonary edema from fluid overload. The priority is to immediately stop the infusion and notify the provider. Diuretic therapy (furosemide) and supplemental oxygen will likely be ordered. Continuing fluid administration will worsen the condition.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #18 2