NCLEX Practice Exam 4 — Questions and Answers
Question 1: All of the following are one of the five rights of delegation EXCEPT the
- right person
- right circumstances
- right supervision/evaluation
- right task
- right communication
- right department (Correct answer)
Correct answer: right department
The 'Five Rights of Delegation' are crucial principles for safe and effective delegation in nursing: right task, right circumstances, right person, right direction/communication, and right supervision/evaluation. These rights ensure that delegated tasks are appropriate and performed competently. 'Right department' is not one of the established components of this framework.
Question 2: Which of the following statements about advocacy is correct?
- Nurses must safeguard a patient’s rights and safety at all times. (Correct answer)
- Nurses must advocate for their patients as long as they align themselves with the treating physician.
- As part of a nurse’s responsibility to advocate for the patient, the nurse must counsel the patient before obtaining informed consent.
- The nurse is responsible for talking the patient into the correct treatment decisions.
Correct answer: Nurses must safeguard a patient’s rights and safety at all times.
Patient advocacy is a core ethical responsibility of nurses, requiring them to protect and support a patient's rights, safety, and best interests at all times. This role involves speaking up for patients, ensuring their voices are heard, and safeguarding their well-being, especially when they are vulnerable or unable to advocate for themselves. It is a constant duty, not conditional on aligning with other healthcare providers or influencing patient decisions.
Question 3: What is one way that a nurse can minimize the chances of being found negligent in court if sued by a patient?
- Do what the nurse believes is correct, especially if the physician appears to be making an incorrect decision.
- Follow the physician’s instructions exactly.
- Follow the wishes of family members of a terminally ill patient, even if they do not have power of attorney.
- Make sure that the nursing practice is in accordance with the standards of care. (Correct answer)
Correct answer: Make sure that the nursing practice is in accordance with the standards of care.
To minimize the risk of being found negligent in court, a nurse must consistently adhere to the established standards of care for their profession. These standards define the expected level of competent and safe nursing practice. By practicing in accordance with these guidelines, nurses demonstrate professional accountability and diligence, which are crucial defenses against claims of negligence.
Question 4: The nurse is caring for a patient who is newly diagnosed with stage IV breast cancer. The patient is expressing anxiety and concerns about an upcoming surgical procedure. The nurse consults the chart and notes that the patient has not signed consent forms for the procedure. How should the nurse respond?
- “Don’t worry about the procedure; you will be fine.”
- “A bilateral mastectomy with dissection of the axillary lymph nodes is the most appropriate treatment for your case.”
- “Let me get your signature on the consent form while we are talking about your surgery.”
- “I understand that you have some concerns about your treatment. Let me get the physician to come in and talk to you.” (Correct answer)
Correct answer: “I understand that you have some concerns about your treatment. Let me get the physician to come in and talk to you.”
Informed consent requires that a patient fully understands the proposed procedure, including risks, benefits, and alternatives, before agreeing to it. Since the patient is expressing anxiety and has not signed the consent form, the nurse's role is to facilitate communication with the physician, who is responsible for providing the necessary information and obtaining informed consent. The nurse should not attempt to explain the procedure or obtain consent when the patient is distressed and needs further clarification from the provider.
Question 5: Which of the following processes will assist patients in obtaining necessary treatments or therapies for optimal outcome?
- Managed care
- Multidisciplinary care
- Case management (Correct answer)
- Health care
Correct answer: Case management
Case management is a collaborative process that involves assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services needed to meet an individual's health requirements. This approach helps patients navigate the healthcare system, access necessary treatments and therapies, and achieve optimal health outcomes by ensuring comprehensive and coordinated care.
Question 6: Health maintenance organizations and preferred provider organizations are examples of what type of organization?
- Managed care (Correct answer)
- Case management
- Quality improvement
- Healthcare
Correct answer: Managed care
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are both prominent examples of managed care organizations. These systems aim to control healthcare costs and improve quality by managing access to services, negotiating rates with providers, and often emphasizing preventive care and coordinated treatment plans.
Question 7: You are responsible for reviewing the nursing unit’s refrigerator. Which of the following drug, if found inside the fridge, should be removed?
- Nadolol (Corgard) (Correct answer)
- Opened (in-use) Humulin N injection
- Urokinase (Kinlytic)
- Epoetin alfa IV (Epogen)
Correct answer: Nadolol (Corgard)
Nadolol (Corgard), a beta-blocker, should typically be stored at room temperature, usually between 20-25°C (68-77°F), and protected from moisture. Refrigeration is generally not recommended for this medication and could potentially affect its stability or efficacy. In contrast, opened insulin, urokinase, and epoetin alfa often require refrigeration for proper storage.
Question 8: A new mother has some questions about phenylketonuria (PKU). Which of the following statements made by a nurse is not correct regarding PKU?
- A Guthrie test can check the necessary lab values.
- The urine has a high concentration of phenylpyruvic acid
- Mental deficits are often present with PKU.
- The effects of PKU are reversible. (Correct answer)
Correct answer: The effects of PKU are reversible.
Phenylketonuria (PKU) is a genetic metabolic disorder where the body cannot process phenylalanine. If left untreated, the accumulation of phenylalanine leads to severe, irreversible brain damage and intellectual disability. While early diagnosis and strict dietary management can prevent the manifestation of symptoms, the underlying metabolic defect is not reversible, and the neurological damage from untreated PKU is permanent.
Question 9: You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect?
- Multiple sclerosis
- Bulimia nervosa
- Systemic sclerosis
- Anorexia nervosa (Correct answer)
Correct answer: Anorexia nervosa
The described symptoms—inability to eat, induced vomiting, severe constipation, and a low Body Mass Index (BMI) of 18 (indicating underweight)—are classic manifestations of anorexia nervosa. This eating disorder is characterized by an intense fear of gaining weight, a distorted body image, and severe restriction of food intake, often accompanied by compensatory behaviors like vomiting.
Question 10: In acid-base balance the normal plasma PCO2 and bicarbonate levels are disturbed. Match the changes in these parameters given below with the disorders in the drop down list. Low plasma PaCO2
- Metabolic Acidosis
- Respiratory Alkalosis (Correct answer)
- Metabolic Alkalosis
- Respiratory Acidosis
Correct answer: Respiratory Alkalosis
Low plasma PaCO2 indicates that the body is exhaling too much carbon dioxide. Since CO2 forms carbonic acid in the blood, a decrease in PaCO2 leads to a reduction in acid levels, causing the blood pH to rise. This elevation in pH due to decreased CO2 is the hallmark of respiratory alkalosis.
Question 11: High plasma PaCO2
- Metabolic Acidosis
- Respiratory Alkalosis
- Metabolic Alkalosis
- Respiratory Acidosis (Correct answer)
Correct answer: Respiratory Acidosis
High plasma PaCO2 indicates that the body is retaining too much carbon dioxide. As CO2 combines with water to form carbonic acid in the blood, an increase in PaCO2 leads to an increase in acid levels. This elevation in acid causes the blood pH to fall, which is the defining characteristic of respiratory acidosis.
Question 12: Decreased plasma bicarbonate (HCO3-)
- Metabolic Acidosis (Correct answer)
- Respiratory Alkalosis
- Metabolic Alkalosis
- Respiratory Acidosis
Correct answer: Metabolic Acidosis
Decreased plasma bicarbonate (HCO3-) signifies a deficit of base in the blood. Bicarbonate is the primary metabolic component of the body's buffering system. A significant reduction in HCO3- directly leads to a decrease in blood pH, which is the definition of metabolic acidosis.
Question 13: Increased plasma bicarbonate (HCO3-)
- Metabolic Acidosis
- Respiratory Alkalosis
- Metabolic Alkalosis (Correct answer)
- Respiratory Acidosis
Correct answer: Metabolic Alkalosis
Increased plasma bicarbonate (HCO3-) indicates an excess of base in the blood. Bicarbonate is the primary metabolic component of the body's buffering system. A significant elevation in HCO3- directly leads to an increase in blood pH, which is the definition of metabolic alkalosis.
Question 14: What two organs in the body serve as a compensatory function to maintain acid base balance?
- Kidneys and Lungs (Correct answer)
- Lungs and Spleen
- Heart and Liver
- Gallbladder and Appendix
Correct answer: Kidneys and Lungs
The lungs and kidneys are the two main organs responsible for maintaining the body's acid-base balance. The lungs regulate carbonic acid levels by controlling the exhalation of carbon dioxide, while the kidneys regulate bicarbonate levels and excrete hydrogen ions to adjust blood pH, acting as crucial compensatory mechanisms.
Question 15: Arterial blood gas (ABG) measurement will give the information needed to determine if the primary disturbance of acid-base balance is respiratory or metabolic in nature.
- TRUE (Correct answer)
- FALSE
- Both Carbonic Acid Excess and Deficit Only
- Both Bicarbonate Excess and Deficit Only
Correct answer: TRUE
Arterial blood gas (ABG) measurements are essential diagnostic tools that provide critical information about a patient's acid-base status. By analyzing parameters such as pH, PaCO2 (partial pressure of carbon dioxide), and HCO3- (bicarbonate), healthcare professionals can accurately determine if the primary acid-base disturbance is respiratory or metabolic in nature.
Question 16: The major effect of acidosis is overexcitement of the central nervous system.
- TRUE
- FALSE (Correct answer)
- Maybe
- Both Acidosis and Alkalosis result in overexcitement of the central nervous system.
Correct answer: FALSE
The major effect of acidosis on the central nervous system (CNS) is depression, not overexcitement. Acidosis can lead to symptoms such as lethargy, confusion, and, in severe cases, coma. Conversely, alkalosis is typically associated with CNS overexcitement, manifesting as nervousness, tremors, and potentially seizures.
NCLEX Practice Exam 4
All of the following are one of the five rights of delegation EXCEPT the