NCLEX-PN Test #19 2

Question 1

A client with esophageal varices is at risk for massive hemorrhage. Which medication is used to reduce portal pressure and variceal bleeding?

Accepted Answer

Octreotide (Sandostatin)

Answer

Octreotide is a somatostatin analogue that reduces splanchnic blood flow and portal pressure, decreasing variceal bleeding. It is given IV in acute variceal hemorrhage as an adjunct to endoscopy. Pantoprazole treats peptic ulcers; lactulose reduces ammonia in hepatic encephalopathy; spironolactone treats ascites.

Question 2

A client with jaundice, right upper quadrant pain, and clay-colored stools is diagnosed with obstructive jaundice. Which laboratory finding is most consistent?

Accepted Answer

Elevated direct (conjugated) bilirubin with elevated alkaline phosphatase (ALP)

Answer

Obstructive jaundice (bile duct blockage by gallstone or tumor) causes conjugated (direct) bilirubin to accumulate in the blood (it is water-soluble and appears in the urine — dark urine) and prevents bile from entering the intestine (clay-colored stools). Elevated direct bilirubin with elevated ALP (cholestatic pattern) is characteristic.

Question 3

The PN is caring for a client after cholecystectomy (laparoscopic). Which teaching point is most important for the first 24 hours at home?

Accepted Answer

Report severe shoulder or abdominal pain, fever, jaundice, or wound drainage that is yellow-green

Answer

After laparoscopic cholecystectomy, warning signs requiring immediate medical evaluation include: severe abdominal or shoulder pain (may indicate bile leak or retained stone), fever > 38°C (infection), jaundice (bile duct injury or retained stone), and purulent wound drainage. Mild diarrhea for a few weeks as the body adjusts to continuous bile flow is expected.

Question 4

A client with ulcerative colitis has bloody diarrhea 8–10 times per day. The nurse assesses the client and notes HR 118 bpm, BP 90/60, pale, and confused. What is the priority action?

Accepted Answer

Initiate IV access, notify the provider, prepare for fluid resuscitation and blood products

Answer

This presentation (tachycardia, hypotension, pallor, confusion with bloody diarrhea) indicates hemorrhagic shock from severe ulcerative colitis flare — a medical emergency. Priorities: IV access × 2, blood type and crossmatch, aggressive fluid resuscitation, notify provider, and prepare for possible emergency colectomy. Airway and IV access are immediate priorities.

Question 5

The nurse is preparing a client for a liver biopsy. Which position should the client be placed in immediately after the procedure?

Accepted Answer

Right lateral decubitus (right side-lying) position with rolled towel under puncture site

Answer

After liver biopsy, the client is positioned on the right side with a small roll or pillow under the puncture site. This uses the body weight to apply pressure to the biopsy site, compressing it against the ribs to prevent hemorrhage. The liver is on the right; right-side lying provides direct pressure to the site.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #19 2