NCLEX-RN Practice Exam 3
A two-year-old child has sustained an injury to the leg and refuses to walk. The nurse in the emergency department documents swelling of the lower affected leg. Which of the following does the nurse suspect is the cause of the child’s symptoms?
The child's refusal to walk, combined with swelling of the limb is suspicious for fracture. Option B: Toddlers will often continue to walk on a muscle that is bruised or strained. Option C: The radius is found in the lower arm and is not relevant to this question. Option D: Toddlers rarely feign injury to be carried, and swelling indicates a physical injury.
The clinic nurse asks a 13-year-old female to bend forward at the waist with arms hanging freely. Which of the following assessments is the nurse most likely conducting?
A check for scoliosis, a lateral deviation of the spine, is an important part of the routine adolescent exam. It is assessed by having the teen bend at the waist with arms dangling, while observing for lateral curvature and uneven rib level. Scoliosis is more common in female adolescents. Options A, B, and C are not part of the routine adolescent exam.
A clinic nurse interviews a parent who is suspected of abusing her child. Which of the following characteristics is the nurse LEAST likely to find in an abusing parent?
The profile of a parent at risk of abusive behavior includes a tendency to blame the child or others for the injury sustained. Options A, B, and D: These parents also have a high incidence of low self-esteem, unemployment, unstable financial situation, and single status.
A toddler has recently been diagnosed with cerebral palsy. Which of the following information should the nurse provide to the parents? Note: More than one answer may be correct.
Delayed developmental milestones are characteristic of cerebral palsy, so regular screening and intervention is essential. Because of injury to upper motor neurons, children may have ocular and speech difficulties. Parent support groups help families to share and cope. Physical therapy and other interventions can minimize the extent of the delay in developmental milestones.
A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient’s lab results would expect which of the following changes in laboratory findings?
The parathyroid glands regulate the calcium level in the blood. In hyperparathyroidism, the serum calcium level will be elevated. Option B: Parathyroid hormone levels may be high or normal but not low. Option C: The body will lower the level of vitamin D in an attempt to lower calcium. Option D: Urine calcium may be elevated, with calcium spilling over from elevated serum levels. This may cause renal stones.
Which of the following conditions most commonly causes acute glomerulonephritis?
Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.
A child has recently been diagnosed with Duchenne’s muscular dystrophy. The parents are receiving genetic counseling prior to planning another pregnancy. Which of the following statements includes the most accurate information?
The recessive Duchenne’s gene is located on one of the two X chromosomes of a female carrier. If her son receives the X bearing the gene he will be affected. Thus, there is a 50% chance of a son being affected. Daughters are not affected, but 50% are carriers because they inherit one copy of the defective gene from the mother. The other X chromosome comes from the father, who cannot be a carrier.
A nurse is caring for a patient with peripheral vascular disease (PVD). The patient complains of burning and tingling of the hands and feet and cannot tolerate touch of any kind. Which of the following is the most likely explanation for these symptoms?
Patients with the peripheral vascular disease often sustain nerve damage as a result of inadequate tissue perfusion. Option B: Fluid overload is not characteristic of PVD. Option C: There is nothing to indicate a psychiatric disturbance in the patient. Option D: Skin changes in PVD are secondary to decreased tissue perfusion rather than primary inflammation.
A patient with leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC (complete blood count) reveals a platelet count of 25,000/microliter. Which of the following actions related specifically to the platelet count should be included in the nursing care plan?
A platelet count of 25,000/microliter is severely thrombocytopenic and should prompt the initiation of bleeding precautions, including monitoring urine and stool for evidence of bleeding. Options A and B: Monitoring for fever and requiring protective clothing are indicated to prevent infection if white blood cells are decreased. Option C: Transfusion of red cells is indicated for severe anemia.
A nurse is providing discharge information to a patient with peripheral vascular disease. Which of the following information should be included in instructions?
Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Option A: Walking barefoot is not advised, as foot protection is important to avoid trauma that may lead to serious infection. Option B: Heating pads can cause injury, which can also increase the risk of infection. Option D: Skin lesions at risk for infection should be examined and treated by a physician.
The nurse is conducting nutrition counseling for a patient with cholecystitis. Which of the following information is important to communicate?
Cholecystitis, inflammation of the gallbladder, is most commonly caused by the presence of gallstones, which may block bile (necessary for fat absorption) from entering the intestines. Patients should decrease dietary fat by limiting foods like fatty meats, fried foods, and creamy desserts to avoid irritation of the gallbladder.
A nurse assigned to the emergency department evaluates a patient who underwent fiberoptic colonoscopy 18 hours previously. The patient reports increasing abdominal pain, fever, and chills. Which of the following conditions poses the most immediate concern?
Bowel perforation is the most serious complication of fiberoptic colonoscopy. Important signs include progressive abdominal pain, fever, chills, and tachycardia, which indicate advancing peritonitis. Options B and C: Viral gastroenteritis and colon cancer do not cause these symptoms. Option D: Diverticulitis may cause pain, fever, and chills, but is far less serious than perforation and peritonitis.
An adolescent brings a physician’s note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?
Osgood-Schlatter disease occurs in adolescents in rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle, causing pain and swelling in the inferior aspect of the knee. Osgood-Schlatter disease is commonly caused by activities that require repeated use of the quadriceps, including track and soccer. Option A: Swimming is not a likely cause. Option B: The condition is usually self-limited, responding to ice, rest, and analgesics. Option D: Continued participation will worsen the condition and the symptoms.
A child is seen in the emergency department for scarlet fever. Which of the following descriptions of scarlet fever is NOT correct?
Petechiae on the soft palate are characteristic of rubella infection. Options A, B, and D are characteristic of scarlet fever, a result of group A Streptococcus infection.
A nonimmunized child appears at the clinic with a visible rash. Which of the following observations indicates the child may have rubeola (measles)?
Koplik's spots are small blue-white spots visible on the oral mucosa and are characteristic of measles infection. Option B: The body rash typically begins on the face and travels downward. Option C: High fever is often present. Option D: "Teardrop on a rose petal" refers to the lesions found in varicella (chickenpox).
A physician has diagnosed acute gastritis in a clinic patient. Which of the following medications would be contraindicated for this patient?
Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the upper GI tract. For this reason, it is contraindicated in a patient with gastritis. Option B: Calcium carbonate is used as an antacid for the relief of indigestion and is not contraindicated. Option C: Clarithromycin is an antibacterial often used for the treatment of Helicobacter pylori in gastritis. Option D: Furosemide is a loop diuretic and is NOT contraindicated in a patient with gastritis.
A child is admitted to the hospital with a diagnosis of Wilms tumor, stage II. Which of the following statements most accurately describes this stage?
The staging of Wilm’s tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual non hematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis.
A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema. Which of the following symptoms should the nurse expect the patient to exhibit?
Patients with pulmonary edema experience air hunger, anxiety, and agitation. Options A and C: Respiration is fast and shallow and heart rate increases. Option B: Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.
An infant is brought to the clinic by his mother, who has noticed that he holds his head in an unusual position and always faces to one side. Which of the following is the most likely explanation?
In torticollis, the sternocleidomastoid muscle is contracted, limiting the range of motion of the neck and causing the chin to point to the opposing side. Option B: In craniosynostosis one of the cranial sutures, often the sagittal, closes prematurely, causing the head to grow in an abnormal shape. Option C: Plagiocephaly refers to the flattening of one side of the head, caused by the infant being placed supine in the same position over time. Option D: Hydrocephalus is caused by a build-up of cerebrospinal fluid in the brain resulting in large head size.
A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern?
Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life-threatening. Repeated vomiting can be an early sign of pressure as the vomiting center within the medulla is stimulated. Option A: The anterior fontanel is closed in a 4-year-old child. Option C: Evidence of sleepiness at 10 PM is normal for a four-year-old. Option D: The average 4-year-old child cannot read yet, so this too is normal.
Claudication is a well-known effect of peripheral vascular disease. Which of the following facts about claudication is correct? Select all that apply:
Claudication describes the pain experienced by a patient with a peripheral vascular disease when oxygen demand in the leg muscles exceeds the oxygen supply. The tissue becomes hypoxic, causing cramping, weakness, and discomfort. Option B: This most often occurs during activity when demand increases in muscle tissue.
A nurse caring for several patients on the cardiac unit is told that one is scheduled for implantation of an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this procedure?
An automatic internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. This is necessary for a patient with significant ventricular symptoms, such as tachycardia resulting in syncope. Option A: A patient with myocardial infarction that resolved with no permanent cardiac damage would not be a candidate. Option B: A patient recovering well from coronary bypass would not need the device. Option D: Atrial tachycardia is less serious and is treated conservatively with medication and cardioversion as a last resort.
A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission?
Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Options A, C, and D: Hepatitis B, C, and D are transmitted through infected bodily fluids.
A patient with a history of diabetes mellitus is on the second post-operative day following cholecystectomy. She has complained of nausea and isn’t able to eat solid foods. The nurse enters the room to find the patient confused and shaky. Which of the following is the most likely explanation for the patient’s symptoms?
A post-operative diabetic patient who is unable to eat is likely to be suffering from hypoglycemia. Confusion and shakiness are common symptoms. Option A: An anesthesia reaction would not occur on the second postoperative day. Options B and D: Hyperglycemia and ketoacidosis do not cause confusion and shakiness.
A patient who has been diagnosed with vasospastic disorder (Raynaud’s disease) complains of cold and stiffness in the fingers. Which of the following descriptions is most likely to fit the patient?
Raynaud’s disease is most common in young women and is frequently associated with rheumatologic disorders, such as lupus and rheumatoid arthritis.
A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?
A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and should be resected as soon as possible. No other appropriate treatment options currently exist.
A child is admitted to the hospital several days after stepping on a sharp object that punctured her athletic shoe and entered the flesh of her foot. The physician is concerned about osteomyelitis and has ordered parenteral antibiotics. Which of the following actions is done immediately before the antibiotic is started?
Antibiotics must be started after the blood culture is drawn, as they may interfere with the identification of the causative organism. Option C: The blood count will reveal the presence of infection but does not help identify an organism or guide antibiotic treatment. Option D: Parental presence is important for the adjustment of the child but not for the administration of medication.
An infant with hydrocele is seen in the clinic for a follow-up visit at 1 month of age. The scrotum is smaller than it was at birth, but fluid is still visible on illumination. Which of the following actions is the physician likely to recommend?
A hydrocele is a collection of fluid in the scrotum that results from a patent tunica vaginalis. Illumination of the scrotum with a pocket light demonstrates the clear fluid. In most cases, the fluid reabsorbs within the first few months of life and no treatment is necessary. Options A and D: Massaging the area or placing the infant in a supine position would have no effect. Option B: Surgery is not indicated.
A 23-year-old patient in the 27th week of pregnancy has been hospitalized on complete bed rest for 6 days. She experiences sudden shortness of breath, accompanied by chest pain. Which of the following conditions is the most likely cause of her symptoms?
In a hospitalized patient on prolonged bed rest, the most likely cause of sudden onset shortness of breath and chest pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep veins of the legs. These clots can then break loose and travel to the lungs. Options A and D: Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart failure due to fluid overload. Option C: There is no reason to suspect an anxiety disorder in this patient. Though anxiety is a possible cause of her symptoms, the seriousness of pulmonary embolism demands that it be considered first.
A patient is admitted to the same day surgery unit for liver biopsy. Which of the following laboratory tests assesses coagulation? (Select all that apply)
Prothrombin time, partial thromboplastin time, and platelet count are all included in coagulation studies. Option D: The hemoglobin level, though important information prior to an invasive procedure like liver biopsy, does not assess coagulation.
A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of the following is a contraindication to the study for this patient?
The implanted pacemaker will interfere with the magnetic fields of the MRI scanner and may be deactivated by them. Option A: Shellfish/iodine allergy is not a contraindication because the contrast used in MRI scanning is not iodine-based. Options C and D: Open MRI scanners and anti-anxiety medications are available for patients with claustrophobia. Psychiatric medication is not a contraindication to MRI scanning.
A patient in the cardiac unit is concerned about the risk factors associated with atherosclerosis. Which of the following are hereditary risk factors for developing atherosclerosis?
A family history of heart disease is an inherited risk factor that is not subject to lifestyle change. Having a first-degree relative with heart disease has been shown to significantly increase risk. Options B and C: Overweight and smoking are risk factors that are subject to lifestyle change and can reduce risk significantly. Option D: Advancing age increases the risk of atherosclerosis but is not a hereditary factor.
Thrombolytic therapy is frequently used in the treatment of suspected stroke. Which of the following is a significant complication associated with thrombolytic therapy?
Cerebral hemorrhage is a significant risk when treating a stroke victim with thrombolytic therapy intended to dissolve a suspected clot. The success of the treatment demands that it be instituted as soon as possible, often before the cause of stroke has been determined. Air embolus is not a concern. Thrombolytic therapy does not lead to Option A: Air embolus is not a concern. Options C and D: Thrombolytic therapy does not lead to the expansion of the clot, but to resolution, which is the intended effect.
A leukemia patient has a relative who wants to donate blood for transfusion. Which of the following donor medical conditions would prevent this?
Hepatitis C is a viral infection transmitted through bodily fluids, such as blood, causing inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to the high risk of infection in the recipient. Cholecystitis (gallbladder disease), diverticulosis, and history of Crohn’s disease do not preclude blood donation.
A patient with Addison’s disease asks a nurse for nutrition and diet advice. Which of the following diet modifications is NOT recommended?
A patient with Addison’s disease requires normal dietary sodium to prevent excess fluid loss. Adequate caloric intake is recommended with a diet high in protein and complex carbohydrates, including grains.
A teen patient is admitted to the hospital by his physician who suspects a diagnosis of acute glomerulonephritis. Which of the following findings is consistent with this diagnosis? Note: More than one answer may be correct.
Acute glomerulonephritis is characterized by high urine specific gravity related to oliguria as well as dark "tea-colored" urine caused by large amounts of red blood cells. Option D: There is periorbital edema, but generalized edema is seen in nephrotic syndrome, not acute glomerulonephritis.
A nurse calls a physician with the concern that a patient has developed a pulmonary embolism. Which of the following symptoms has the nurse most likely observed?
Typical symptoms of pulmonary embolism include chest pain, shortness of breath, and severe anxiety. The physician should be notified immediately. Options A and C: A patient with pulmonary embolism will not be sleepy or have a cough with crackles on the exam. Option D: A patient with fever, chills, and loss of appetite may be developing pneumonia.
A nurse is assigned to the pediatric rheumatology clinic and is assessing a child who has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?
Nonsteroidal anti-inflammatory drugs are important first line treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Options A and B: Half of children with the disorder recover without joint deformity and about a third will continue with symptoms into adulthood. Option D: Physical activity is an integral part of therapy.
A child weighing 30 kg arrives at the clinic with diffuse itching as the result of an allergic reaction to an insect bite. Diphenhydramine (Benadryl) 25 mg 3 times a day is prescribed. The correct pediatric dose is 5 mg/kg/day. Which of the following best describes the prescribed drug dose?
This child weighs 30 kg, and the pediatric dose of diphenhydramine is 5 mg/kg/day (5 X 30 = 150/day). Therefore, the correct dose is 150 mg/day. Divided into 3 doses per day, the child should receive 50 mg 3 times a day rather than 25 mg 3 times a day. Dosage should not be titrated based on symptoms without consulting a physician.
The mother of a 2-month-old infant brings the child to the clinic for a well-baby check. She is concerned because she feels only one testis in the scrotal sac. Which of the following statements about the undescended testis is the most accurate?
Normally, the testes descend by one year of age. In young infants, it is common for the testes to retract into the inguinal canal when the environment is cold or the cremasteric reflex is stimulated. Exam should be done in a warm room with warm hands. It is most likely that both testes are present and will descend by a year. If not, a full assessment will determine the appropriate treatment.
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