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NCLEX-PN PDF DEMO:
QUESTION NO: 1
In a disaster situation, the nurse assessing a diabetic client on insulin assesses for all of the following except:
A. diabetic signs and symptoms.
B. nutritional status.
C. bleeding problems.
D. availability of insulin.
Answer: C
Explanation:
Bleeding problems are not characteristic of diabetes. All the other options are appropriate areas of assessment.
Safety and Infection Control
QUESTION NO: 2
After 12 months of cessation of menses, which of the following assessment findings in a client who is taking hormone replacement therapy should the nurse report to the physician immediately?
A. breast tenderness
B. weight gain
C. fluid retention
D. uterine bleeding
Answer: D
Explanation:
Uterine bleeding on combination hormone replacement therapy, after 12 months of menses cessation, indicates an increased risk of carcinoma and should be reported to the physician immediately. Breast tenderness, weight gain, and fluid retention are all routine side effects ofhormone replacement therapy. They should be noted in the record and reported to the physician, but they are not urgent.Health Promotion and Maintenance
QUESTION NO: 3
While walking in the hallway of an acute care unit of the hospital, the nurse overhears the change of shift report. The nurse should:
A. make the charge nurse on the unit aware of the situation so that he or she can take the necessary steps to maintain the confidentiality of the information being reported.
B. disregard the information because it changes quickly on the acute care unit and is outdated within
2-3 hours anyway.
C. return to his or her own unit and not disclose that confidential information has been overheard.
D. ignore the situation.
Answer: A
Explanation:
To protect the confidentiality of the information being reported, the nurse should make the charge nurse on the unit aware of the situation so that the information can be communicated in an appropriate way in privacy.
Coordinated Care
QUESTION NO: 4
If a client has chronic renal failure, which of the following sexual complications is the client at risk of developing?
A. retrograde ejaculation
B. decreased plasma testosterone
C. hypertrophy of testicles
D. state of euphoria
Answer: B
Explanation:
Untreated chronic renal failure causes decreased testosterone levels, atrophy of testicles, and decreased spermatogenesis. Retrograde ejaculation is not a complication of chronic renal failure. It is a complication of transurethral resection of the prostate. In chronic renal failure, the testicles atrophy; they do not hypertrophy. Chronic renal failure produces a state of depression, not euphoria.Health Promotion and Maintenance
QUESTION NO: 5
A client has chronic respiratory acidosis caused by end-stage chronic obstructive pulmonary disease (COPD). Oxygen is delivered at 1 L/min per nasal cannula. The nurse teaches the family that the reason for this is to avoid respiratory depression, based on which of the following explanations?
A. COPD clients are stimulated to breathe by hypoxia.
B. COPD clients depend on a low carbon dioxide level.
C. COPD clients tend to retain hydrogen ions if they are given high doses of oxygen.
D. COPD clients thrive on a high oxygen level.
Answer: A
Explanation:
COPD clients are compensating for low oxygen and high carbon dioxide levels. Hypoxia is the main stimulus to breathe in persons with chronic hypercapnia. Increasing the level of oxygen decreases the stimulus to breathe.
Physiological Adaptation
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Updated: May 27, 2022