NCLEX-RN Free Practice Test

- (Topic 3)
A client had a myocardial infarction 5 days ago. His physician has ordered an echocardiogram to determine how his myocardial infarction has affected his ventricular wall motion. When the client asks if this test is painful, an appropriate response is:

1. A. ??No, but you must be able to ride on a stationary bicycle while the test is being performed.??
2. B. ??No, but you will have to lie still and the gel that is used may be cool.??
3. C. ??Yes, but your physician will be there and will order pain medicine for you.??
4. D. ??Your physician has ordered medicine, which you will be given before you go for the test, which will make you sleepy.??

Correct Answer: B
(A) Riding a stationary bicycle or walking on a treadmill is done during a stress test. (B) During an echocardiogram, the client must lie supine while a technician performs the test. To perform the test, the technician uses a conductive gel and a transducer to obtain ultrasound tracings of the heart. (C) A physician need not be present during an echocardiogram, and it is neither invasive nor painful. (D) There is no premedication required for an echocardiogram.

- (Topic 1)
In assessing cardiovascular clients with progression of aortic stenosis, the nurse should be aware that there is typically:

1. A. Decreased pulmonary blood flow and cyanosis
2. B. Increased pressure in the pulmonary veins and pulmonary edema
3. C. Systemic venous engorgement
4. D. Increased left ventricular systolic pressures and hypertrophy

Correct Answer: D
(A) These signs are seen in pulmonic stenosis or in response to pulmonary congestion and edema and mitral stenosis. (B) These signs are seen primarily in mitral stenosis or as a late sign in aortic stenosis after left ventricular failure. (C) These signs are seen primarily in right-sided heart valve dysfunction. (D) Left ventricular hypertrophy occurs to increase muscle mass and overcome the stenosis; left ventricular pressures increase as left ventricular volume increases owing to insufficient emptying.

- (Topic 2)
A client is being discharged and will continue enteral feedings at home. Which of the following statements by a family member indicates the need for further teaching?

1. A. ??If he develops diarrhea lasting for more than 2–3 days, I will contact the doctor or nurse.??
2. B. ??I should anticipate that he will gain about 1 lb/day now that he is on continuous feedings.??
3. C. ??It is important to keep the head of his bed elevated or sit him in the chair during feedings.??
4. D. ??I should use prepared or open formula within 24 hours and store unused portions in the refrigerator.??

Correct Answer: B
(A) Diarrhea is a complication of tube feedings that can lead to dehydration. Diarrhea may be the result of hypertonic formulas that can draw fluid into the bowel. Other causes of diarrhea may be bacterial contamination, fecal impaction, medications, and low albumin.
(B) A consistent weight gain of more than 0.22 kg/day (12 lb/day) over several days should be reported promptly. The client should be evaluated for fluid volume excess. (C) Elevating the client??s head prevents reflux and thus formula from entering the airway. (D) Bacteria proliferate rapidly in enteral formulas and can cause gastroenteritis and even sepsis.

- (Topic 4)
A 72-year-old male client had the Foley catheter that was inserted during the transurethral resection of his prostate removed today. He is concerned about the urinary incontinence he is having since removal of the Foley catheter. The nurse explains that:

1. A. He should not be concerned about it because it will resolve quickly
2. B. This is usually temporary
3. C. The nurse will keep him dry, and he should notify the nurse when this happens
4. D. This is related to the bladder spasms and will soon stop

Correct Answer: B
(A) This problem is temporary, but it may take some time to resolve, especially in an older man. (B) This problem is usually temporary, but it may take some time to resolve. (C) Keeping the client dry will not relieve his anxiety about his incontinence. (D) The bladder spasms are not the cause of the client??s incontinence.

- (Topic 4)
A client has just been transferred to the floor from the labor and delivery unit following delivery of a stillborn term infant. She is very despondent. When the nurse attempts to take her vital signs, she responds in anger, stating, ??You leave me alone. You don??t care anything about me. It??s people like you who let my baby die.?? The nurse??s best course of action is to:

1. A. Quietly leave her room, allowing her more private time to deal with her loss.
2. B. Tell her that what happened was for the best and that she is still young and can have other children.
3. C. Tell her how sorry you are, and let her know that her child is now a little angel in heaven.
4. D. Tell her how sorry you are about the loss of her baby, and acknowledge her anger as being a normal stage of grie
5. E. Assure her that you are there to help her in any way you can.

Correct Answer: D
(A) Parents do need their privacy following a loss, but the nurse still has a responsibility to provide postpartum physical care. (B) This is a negative statement, which is not therapeutic. The client is not concerned about future children but is in the first stages of grief, denial, and anger. (C) This is a negative statement, which is not therapeutic. The client does not want to hear about her baby in heaven. She cannot believe that God could love or want her child more than she could. (D) Acknowledging that anger is normal and beneficial will help the client to understand the normal stages of grief. Expressing sorrow over her loss and assuring her that the support is there to take care of her physical and emotional needs will help to promote a trusting relationship.