National Council Licensure Examination (NCLEX) is an exam that a fellow nurse has to pass in order to get licensed to legally practice as a nurse in the United States. A prospective nurse must pass either a NCELX-RN (to become registered nurse) or NCLEX-PN (to practice as a practical nurse) after completion of nursing school. According to the data from the NCLEX statics, a candidate studied in the US has good passing percentage of 87.50% while as student from other countries have very low passing rate of 38.26%. Student apart from US educated have a great problem dealing NCLEX exam. My blog with some samples questions with rational answers might help those students who wish to appear in NCLEX exam. I will be submitting around 20 questions with rational answers in each of blog. Hope my effort will help international students.
1. After the lungs, the kidneys work to maintain body pH. The best explanation of how the kidneys accomplish regulation of pH is that they
a. Secrete hydrogen ions and sodium.
b. Secrete ammonia.
c. Exchange hydrogen and sodium in the kidney tubules.
d. Decrease sodium ions, hold on to hydrogen ions, and then secrete sodium bicarbonate.
2.. A female client has orders for an oral cholecystogram. Prior to the test, the nursing intervention would be to
a. Provide a high fat diet for dinner, then NPO
b. Explain that diarrhea may result from the dye tablets
c. Administer the dye tablets following a regular diet for dinner
d. Administer enemas until clear
3. The nurse explains to a client who has just received the diagnosis of Noninsulin-Dependent Diabetes Mellitus (NIDDM) that sulfonylureas, one group of oral hypoglycemic agents, act by
a. Stimulating the pancreas to produce or release insulin
b. Making the insulin that is produced more available for use
c. Lowering the blood sugar by facilitating the uptake and utilization of glucose
d. Altering both fat and protein metabolism
4. Myasthenic crisis and cholinergic crisis are the major complications of myasthenia gravis. Which of the following is essential nursing knowledge when caring for a client in crisis?
a. Weakness and paralysis of the muscles for swallowing and breathing occur in either crisis
b. Cholinergic drugs should be administered to prevent further complications associated with the crisis
c. The clinical condition of the client usually improves after several days of treatment
d. Loss of body function creates high levels of anxiety and fear
5. A 54-year-old client was put in Quinidine (a drug that decreases myocardial excitability) to prevent atrial fibrillation. He also has kidney disease. The nurse is aware that this drug, when given to a client with kidney disease, may
a. Cause cardiac arrest
b. Cause hypotension
c. Produce mild bradycardia
d. Be very toxic even in small doses
6. A client is about to be discharged on the drug bishydroxycoumarin (Dicumarol). Of the principles below, which one is the most important to teach the client before discharge?
a. He should be sure to take the medication before meals
b. He should shave with an electric razor
c. If he misses a dose, he should double the dose at the next scheduled time
d. It is the responsibility of the physician to do the teaching for this medication
7. A cyanotic client with an unknown diagnosis is admitted to the emergency room. In relation to oxygen, the first nursing action would be to
a. Wait until the client's lab work is done
b. Not administer oxygen unless ordered by the physician
c. Administer oxygen at 2 liters flow per minute
d. Administer oxygen at 10 liters flow per minute and check the client's nail beds
8. A client with a diagnosis of gout will be taking colchicine and allopurinol bid to prevent recurrence. The most common early sign of colchicine toxicity that the nurse will assess for is
a. Blurred vision
b. Anorexia
c. Diarrhea
d. Fever
9. A client has chronic dermatitis involving the neck, face and antecubital creases. She has a strong family history of varied allergy disorders. This type of dermatitis is probably best described as
a. Contact dermatitis
b. Atopic dermatitis
c. Eczema
d. Dermatitis medicamentosa
10 . The physician has just completed a liver biopsy. Immediately following the procedure, the nurse will position the client
a. On his right side to promote hemostasis
b. In Fowler's position to facilitate ventilation
c. Supine to maintain blood pressure
d. In Sims' position to prevent aspiration
11 When a client has peptic ulcer disease, the nurse would expect a priority intervention to be
a. Assisting in inserting a Miller-Abbott tube
b. Assisting in inserting an arterial pressure line
c. Inserting a nasogastric tube
d. Inserting an IV
12. The nurse would expect to find an improvement in which of the blood values as a result of dialysis treatment?
a. High serum creatinine levels
b. Low hemoglobin
c. Hypocalcemia
d. Hypokalemia
13. A 24-year-old client is admitted to the hospital following an automobile accident. She was brought in unconscious with the following vital signs: BP 130/76, P 100, R 16, T 98F. The nurse observes bleeding from the client's nose. Which of the following interventions will assist in determining the presence of cerebrospinal fluid?
a. Obtain a culture of the specimen using sterile swabs and send to the laboratory
b. Allow the drainage to drip on a sterile gauze and observe for a halo or ring around the blood
c. Suction the nose gently with a bulb syringe and send specimen to the laboratory
d. Insert sterile packing into the nares and remove in 24 hours
14. A 24-year-old male is admitted with a possible head injury. His arterial blood gases show that his pH is less than 7.3, his PaCO2 is elevated above 60 mmHg, and his PaO2 is less than 45 mmHg. Evaluating this ABG panel, the nurse would conclude that
a. Edema has resulted from a low pH state
b. Acidosis has caused vasoconstriction of cerebral arterioles
c. Cerebral edema has resulted from a low oxygen state
d. Cerebral blood flow has decreased
15 In preparation for discharge of a client with arterial insufficiency and Raynaud's disease, client teaching instructions should include
a. Walking several times each day as a part of an exercise routine
b. Keeping the heat up so that the environment is warm
c. Wearing TED hose during the day
d. Using hydrotherapy for increasing oxygenation
16. A client is admitted following an automobile accident in which he sustained a contusion. The nurse knows that the significance of a contusion is
a. That it is reversible
b. Amnesia will occur
c. Loss of consciousness may be transient
d. Laceration of the brain may occur
17. A client with tuberculosis is given the drug pyrazinamide (Pyrazinamide). Which one of the following diagnostic tests would be inaccurate if the client is receiving the drug?
a. Liver function test
b. Gall bladder studies
c. Thyroid function studies
d. Blood glucose
18. Which one of the following conditions could lead to an inaccurate pulse oximetry reading if the sensor is attached to the client's ear?
a. Artificial nails
b. Vasodilation
c. Hypothermia
d. Movement of the head
19. While on a camping trip, a friend sustains a snake bite from a poisonous snake. The most effective initial intervention would be to
a. Place a restrictive band above the snake bite
b. Elevate the bite area above the level of the heart
c. Position the client in a supine position
d. Immobilize the limb
20. There is a physician's order to irrigate a client's bladder. Which one of the following nursing measures will ensure patency?
a. Use a solution of sterile water for the irrigation
b. Apply a small amount of pressure to push the mucus out of the catheter tip if the tube is not patent
c. Carefully insert about 100 mL of aqueous Zephiran into the bladder, allow it to remain for 10 hour, and then siphon it out
d. Irrigate with 20mL's of normal saline to establish patency
Answers
1. Answer: d
Rationale: By decreasing NA+ ions, holding onto hydrogen ions, and secreting sodium bicarbonate, the kidneys can regulate pH. Therefore, this is the most complete answer, and while this buffer system is the slowest, it can completely compensate for acid-base imbalance.
2. Answer: b
Rationale: Diarrhea is a very common response to the dye tablets. A dinner of tea and toast is usually given to the client. Each dye tablet is given at 5 minute intervals, usually with 1 glass of water following each tablet. The number of tablets prescribed will vary, because it is based on the weight of the client.
3. Answer: a
Rationale: Sulfonylurea drugs, Orinase for example, lowers the blood sugar by stimulating the beta cells of the pancreas to synthesize and release insulin.
4. Answer: a
Rationale: The client cannot handle his own secretions, and respiratory arrest may be
imminent. Atropine may be administered to prevent crisis. Anticholinergic drugs are administered to increase the levels of acetylcholine at the myoneural junction. Cholinergic drugs mimic the actions of the parasympathetic nervous system and would not be used.
5. Answer: a
Rationale: Kidney disease interferes with metabolism and excretion of Quinidine, resulting in higher drug concentrations in the body. Quinidine can depress myocardial excitability enough to cause cardiac arrest.
6. Answer: b
Rationale: Dicumarol is an anticoagulant drug and one of the dangers involved is bleeding. Using a safety razor can lead to bleeding through cuts. The drug should be given at the same time daily but not related to meals. Due to danger of bleeding, missed doses should not be made up.
7. Answer: c
Rationale: Administer oxygen at 2 liters per minute and no more, for if the client is emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function
8. Answer: c
Rationale: Diarrhea is by far the most common early sign of colchicine toxicity. When given in the acute phase of gout, the dose of colchicine is usually 0.6 mg (PO) q hr (not to exceed 10 tablets) until pain is relieved or gastrointestinal symptoms ensue.
9. Answer: b
Rationale: Atopic dermatitis is chronic, pruritic and allergic in nature. Typically it has a longer course than contact dermatitis and is aggravated by commercial face or body lotions, emotional stress, and, in some instances, particular foods.
10. Answer: a
Rationale: Placing the client on his right side will allow pressure to be placed on the puncture site, thus promoting hemostasis and preventing hemorrhage. The other positions will not be effective in achieving these goals.
11. Answer: c
Rationale: An NG tube insertion is the most appropriate intervention because it will determine
the presence of active gastrointestinal bleeding. A Miller-Abbott tube is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line is not appropriate at this time and an IV is optional.
12. Answer: a
Rationale: High creatinine levels will be decreased. Anemia is a result of decreased production of erythropoietin by the kidney and is not affected by hemodialysis. Hyperkalemia and high base bicarbonate levels are present in renal failure clients.
13. Answer: b
Rationale: The halo or "bull's eye" sign seen when drainage from the nose or ear of a
head-injured client is collected on a sterile gauze is indicative of CSF in the drainage. The collection of a culture specimen using any type of swab or suction would be contraindicated because brain tissue may be inadvertently removed at the same time or other tissue damage may result.
14. Answer: c
Rationale: Hypoxic states may cause cerebral edema. Hypoxia also causes cerebral vasodilatation particularly in response to a decrease in the PaO2 below 60 mmHg.
15. Answer: b
Rationale: The client's instructions should include keeping the environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and socks will also be useful in preventing vasoconstriction, but TED hose would not be therapeutic. Walking will most likely increase pain.
16. Answer: d
Rationale: Laceration, a more severe consequence of closed head injury, occurs as the brain tissue moves across the uneven base of the skull in a contusion. Contusion causes cerebral dysfunction which results in bruising of the brain. A concussion causes transient loss of consciousness, retrograde amnesia, and is generally reversible.
17. Answer: a
Rationale: Liver function tests can be elevated in clients taking pyrazinamide. This drug is used when primary and secondary antitubercular drugs are not effective. Urate levels may be increased and there is a chemical interference with urine ketone levels if these tests are done while the client is on the drug.
18. Answer: c
Rationale: Hypothermia or fever may lead to an inaccurate reading. Artificial nails may distort a reading if a finger probe is used. Vasoconstriction can cause an inaccurate reading of oxygen saturation. Arterial saturations have a close correlation with the reading from the pulse oximeter as long as the arterial saturation is above 70 percent.
19. Answer: a
Rationale: A restrictive band 2 to 4 inches above the snake bite is most effective in
containing the venom and minimizing lymphatic and superficial venous return. Elevation of the limb or immobilization would not be effective interventions.
20. Answer: d
Rationale: Normal saline is the fluid of choice for irrigation. It is never advisable to force fluids into a tubing to check for patency. Sterile water and aqueous Zephiran will affect the pH of the bladder as well as cause irritation.
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