NCLEX-RN PRACTICE QUESTION (OA)

When assessing a patient diagnosed with osteoarthritis (OA), the healthcare provider looks for which characteristic of this condition?

Please choose from one of the following options.

• 
  

  Waddling gait
• 
  

  Decreased grip strength
• 
  

  Joint crepitus
• 
  

  Bilateral joint swelling

HINTS:

1.  Malfunction of the chondrocytes, the cells that create and sustain cartilage, is a key feature OA pathogenesis.

2.  The function of cartilage is to cushion the joints.

3.  Crepitus is present when cartilage is lost. It is characterized by a popping, grating sound, or sometimes the patient feels bone rubbing against bone secondary to loss of cartilage. Decreased grip strength and bilateral joint swelling are more often seen in rheumatoid arthritis. A waddling gait (a duck-like gait) is sometimes seen in the third trimester of pregnancy (due to anatomical and hormonal changes) or with muscular diseases such as muscular dystrophy.

ANSWER: 3

NCLEX-RN PRACTICE QUESTION

NCLEX-RN PRACTICE QUESTION

1.  A patient is prescribed ibuprofen 800 mg every 4 hours for the treatment of rheumatoid arthritis (RA). Which of these clinical manifestations should the healthcare provider anticipate observing if the patient is developing an adverse effect from the medication?

Select all that apply.

Select all that apply.

• Patient report of epigastric pain
• Positive fecal occult blood test
• Decreased serum albumin
• Increased blood urea nitrogen (BUN)
• Increased serum hematocrit

HINTS:

1.  Recall the medication’s mechanism of action.

2.  NSAIDs like ibuprofen inhibit COX-1 and COX-2

3.  Inhibiting COX-1 and COX-2 results in decreased prostaglandins

4.  Pain is managed when COX-1 is inhibited.

5.  COX-2 is sometimes referred to as “good COX” (while COX-1 is sometimes called “bad COX), because when COX-2 is inhibited, prostaglandins that serve important normal functions are impaired. Prostaglandins are needed for the integrity of the peptic mucosal lining and maintenance of renal perfusion. Epigastric pain (peptic ulcer), blood in the stool (bleeding ulcer), and increased BUN (decreased renal perfusion and increased reabsorption of blood from the GI tract) are all indications that the patient may be experiencing a bleeding peptic ulcer.

ANSWER: 1, 2, 4

NCLEX-RN PRACTICE QUESTION/ASTHMA DURING PREGNANCY

NCLEX-RN Practice Question

A patient who has mild intermittent asthma is 23 weeks pregnant. Which of these recommendations will the healthcare provider give the patient to promote the health of the woman and her baby? Select all that apply.

“Measure your peak flow rate once or twice per day.”

“Keep all of your appointments for non-stress testing .”

“Avoid exercise while you are pregnant because this can trigger an attack.”

“You should not receive a flu shot until after the baby is born.”

“Use a humidifier in your home to increase the level of humidity.”

“Call our office immediately if you notice a decrease in your baby’s movements.”

HINTS:
Recommendations for this patient are aimed at controlling asthma severity because poorly controlled asthma can cause maternal hypoxia and impairment of fetal oxygenation.

Because there are no known risks of the flu shot for a developing fetus, women who are pregnant during flu season should receive a flu shot.

Increasing humidity can increase dust and dust mite activity and trigger an asthma attack.

Vigorous exercise may trigger an asthma attack in some patients but moderate exercise should not be discouraged.

The woman should monitor her peak flow rate because decreasing flow rates usually signal a worsening of asthma even if she is feeling well.

CORRECT ANSWER:
Items 1, 2, 4, 6

NCLEX-RN PRACTICE QUESTION/INDERAL

The healthcare provider is performing an assessment on a patient who is taking propranolol (Inderal) for supraventricular tachycardia. Which assessment finding is an indication the patient is experiencing an adverse effect of this drug?

1. Dry mouth 2. Bradycardia 2. Urinary retention 4. ParesthesiaHint: Propranolol is a nonselective beta-adrenergic antagonist.

Hint @2 Beta-1 receptors are found in the cardiac conduction system and myocytes.

Hint: Propranolol is a nonselective beta-adrenergic antagonist.

Answer is #2 Bradycardia

NCLEX-RN PRACTICE QUESTION/MED CALCULATION

NCLEX-RN PRACTICE QUESTION:

The order is to administer 15 mg of morphine IM. It is supplied as gr 1/6 per mL. How much would you give?

A. 4.5 mL
B. 4 mL
C. 2 mL
D. 1.5 mL



ANSWER: D
15mg X 1gr/60mg X 1ml/1/6gr = 1.5ml

NCLEX-RN PRACTICE QUESTION/CPR

NCLEX Practice Question:

The healthcare provider is caring for a patient on a telemetry unit. The patient loses consciousness, and the healthcare provider and notes this waveform on the patient’s cardiac monitor. Which intervention should the healthcare provider do first?

1. Ask the unit secretary to call the cardiologist.
2. Begin cardiopulmonary resuscitation (CPR) and call for a defibrillator.
3. Document the findings and continue to monitor.
4. Administer 100% oxygen via face mask at 8 liters/minute.

Try to answer before looking below at the hints

Hints:
1. The heart rhythm is irregular.
2. There are no P waves and the PR interval is not measurable.
3. Instead of QRS complexes, there are irregular undulating waves.
4. Because the ventricles are fibrillating, treatment will include immediate defibrillation along with CPR

Correct Answer is 2

NCLEX-RN PRACTICE QUESTION/LASIX

NCLEX-RN EXAM PRACTICE QUESTION:

A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the infusion, which of the following symptoms is NOT expected?

A. Increased urinary output.
B. Decreased edema.
C. Decreased pain.
D. Decreased blood pressure.

HINTS:
Furosemide is a loop diuretic
Furosemide does not alter pain.
Furosemide acts on the kidneys to increase urinary output.
Fluid may move from the periphery, decreasing edema.
Fluid load is reduced, lowering blood pressure.

ANSWER: C

NCLEX-RN PRACTICE QUESTION/ABG

NCLEX-RN REVIEW QUESTION:

The arterial blood gasses of a patient with severe chronic obstructive pulmonary disease (COPD) are: 
pH 7.34, PaO2 80mmHg, PaCO2 47mmHg,HCO3 28mEq/L. 

Based on these findings, what is the priority action of the nurse?
1. Administer oxygen 4L/minute via mask.
2. No action is required at this time.
3. Administer an IV corticosteroid.
4. Perform vigorous suctioning

HINTS:

Look at the pH to determine if the value is normal, basic, or acidic.

Look at the HCO3−level. Is it higher or lower than normal?

What about the patient’s history makes you think there may be an alteration in the pH?

Are there some conditions where the patient normally has an altered blood gas result?

This patient has mild respiratory acidosis which can be normal for a patient with COPD. No action is needed. A patient may only be mildly hypoxic in the early stages of COPD, but as the disease progresses, increasing hypoxia stimulates hyperventilation and respiratory alkalosis. In later stages, chronic CO2 retention and respiratory acidosis occurs. Also remember that the administration of oxygen to a patient with COPD can cause a depression in the respiratory drive.

CORRECT ANSWER: 2

NCLEX-RN PRACTICE QUESTION/FLU SHOT

NCLEX-RN Practice Question of the Day
The healthcare provider understands that teaching has been effective when the patient verbalizes the following regarding influenza vaccinations:

1. “Since the vaccine is the live virus, I can expect to be ill for 4-7 days after receiving my shot.”

2. “Influenza vaccines are a cure for the flu.”

3. “The vaccine is an inactivated virus, but may cause some mild cold-like symptoms.”

4. “If I have already had the vaccine last year, it is not recommended that I get it again this year.”

HINTS:
The flu vaccine is recommended annually to protect individuals against the influenza virus.

Because the vaccine is not a live virus, individuals will not contract the virus and it’s ill effects.

The flu vaccine is an inactivated virus. Though the virus itself has been destroyed, some parts of the protein shell remain intake. The body is able to recognize these proteins as a foreign body and and create antibodies to protect the individual from it. Because the body is creating a defense system, the individual may develop very mild cold-like symptoms.

ANSWER: #3

NCLEX-RN PRACTICE QUESTION/INFANT RESPIRATORY

NCLEX-RN Practice Question:

A 6-month-old infant who was seen in the Emergency Department with wheezing and coughing is admitted to the pediatric unit with a diagnosis of bronchiolitis. During the admission assessment, which of these will alert the healthcare provider the infant’s condition is worsening?

1. Respiratory rate of 38 breaths/min
2. Decreased inspiratory breath sounds
3. Irritability and crying
4. Dysphasia and loss of appetite

HINTS:

A respiratory rate of 38 is within normal limits for a 6-month-old infant.

Irritability and crying may be expected in young children who are hospitalized.

Decreased breath sounds may indicate impending respiratory failure because less air is moving into the lungs.

ANSWER: 2

NCLEX-RN PRACTICE QUESTION/PLEURAL EFFUSION

NCLEX-RN Practice Question

The healthcare provider is providing teaching on pleural effusions. The healthcare provider understands that teaching has been effective when the patient states:

1. “A pleural effusion is accumulation of fluid in the airways of the lungs.”

2. “A pleural effusion is an accumulation of fluid in the pleural cavity.”

3. “A pleural effusion is an accumulation of blood in the airspace.”

4. “A pleural effusion is an accumulation of fluid in the alveoli.”

HINTS:
A pleural effusion is an accumulation of fluid in the respiratory system.

The accumulation of fluid is in a space that is not part of the airways.

A pleural effusion is fluid accumulation in the pleural cavity.

ANSWER: 2

NCLEX-RN PRACTICE QUESTION/HYPERKALEMIA

NCLEX-RN PRACTICE QUESTION:

The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq KCL in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued?

A. Narrowed QRS complex
B. Shortened “PR” interval
C. Tall peaked T waves
D. Prominent “U” waves

CORRECT ANSWER:
The correct answer is C: A tall peaked T wave is a sign of hyperkalemia.

NCLEX-RN PRACTICE QUESTION/DVT and PREG

NCLEX-RN PRACTICE QUESTION:

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?

A. Myocardial infarction due to a history of atherosclerosis.
B. Pulmonary embolism due to deep vein thrombosis (DVT).
C. Anxiety attack due to worries about her baby’s health.
D. Congestive heart failure due to fluid overload.

HINTS/RATIONALE:
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.

Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart failure due to fluid overload.

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.

Answer: B

NCLEX-RN PRACTICE QUESTION/t-PA

NCLEX-RN Practice Question:

Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA?

A. Worsening chest pain that began earlier in the evening.
B. History of cerebral hemorrhage.
C. History of prior myocardial infarction.
D. Hypertension.

HINTS:
t-PA acts by dissolving the clot which is blocking the coronary artery.
t-PA works best when administered within 6 hours of onset of symptoms.
Prior MI is not a contraindication to t-PA.
Patients receiving t-PA should be observed for changes in blood pressure, as t-PA may cause hypotension.
A history of cerebral hemorrhage is a contraindication to t-PA because it may increase the risk of bleeding.

ANSWER: B