NCLEX-RN Practice Test 17

Question 1

A client with a pituitary tumor has had a transsphenoidal hypophysectomy. Which of the following interventions would be appropriate for this client?

Accepted Answer

Elevate the head of the bed 30°

Answer

Place the client in Trendelenburg position for postural drainage

Answer

Encourage coughing and deep breathing every 2 hours

Answer

Encourage the Valsalva maneuver for bowel movements

Question 2

A patient received surgery and chemotherapy for colon cancer, completing therapy 3 months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations could account for her symptoms?

Accepted Answer

The symptoms may be the result of anemia caused by chemotherapy.

Answer

The patient may be immunosuppressed.

Answer

The patient may be depressed.

Answer

The patient may be dehydrated.

Question 3

A 33-year-old male is being evaluated for possible acute leukemia. Which of the following would the nurse inquire about as a part of the assessment?

Accepted Answer

The client had radiation for treatment of Hodgkin’s disease as a teenager.

Answer

The client collects stamps as a hobby.

Answer

The client recently lost his job as a postal worker.

Answer

The client’s brother had leukemia as a child.

Question 4

Which of the following would be the priority nursing diagnosis for the adult client with acute leukemia?

Accepted Answer

Risk for injury related to thrombocytopenia

Answer

Oral mucous membrane, altered related to chemotherapy

Answer

Fatigue related to the disease process

Answer

Interrupted family processes related to life-threatening illness of a family member

Question 5

A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform?

Accepted Answer

Check blood pressure.

Answer

Ask the patient to lie down on the exam table.

Answer

Draw blood for chemistry panel and arterial blood gas (ABG).

Answer

Send the patient for a chest x-ray.

Question 6

The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical manifestations would be most indicative of the anemia?

Accepted Answer

Respirations 28 shallow

Answer

BP 146/88

Answer

Weight gain of 10 pounds in 6 months

Answer

Pink complexion

Question 7

A patient is admitted to the hospital with suspected polycythemia vera. Which of the following symptoms is consistent with the diagnosis? Select all that applies.

Accepted Answer

Increased clotting time.

Answer

Weight loss.

Question 8

A nurse is caring for patients in the oncology unit. Which of the following is the most important nursing action when caring for a neutropenic patient?

Accepted Answer

Change gloves immediately after use.

Answer

Change the disposable mask immediately after use.

Answer

Minimize patient contact.

Answer

Minimize conversation with the patient.

Question 9

A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse complaining of frequent headaches. Which of the following responses to the patient is correct?

Accepted Answer

“Headaches are a frequent side effect of nitroglycerine because it causes vasodilation.”

Answer

“Stop taking the nitroglycerin and see if the headaches improve.”

Answer

“Go to the emergency department to be checked because nitroglycerin can cause bleeding in the brain.”

Answer

“The headaches are unlikely to be related to the nitroglycerin, so you should see your doctor for further investigation.”

Question 10

Which of the following terms refer to the degree to which an instrument measures what it is supposed to be measure?

Accepted Answer

Validity

Answer

Reliability

Answer

Meaningfulness

Answer

Sensitivity

A client with a pituitary tumor has had a transsphenoidal hypophysectomy.Which of the following interventions would be appropriate for this client?

A client with a pituitary tumor has had a transsphenoidal hypophysectomy.
Which of the following interventions would be appropriate for this client?