NCLEX-RN Free Practice Test

- (Topic 5)
For the past several months, an elderly female client with Alzheimer??s disease has experienced paranoia; hallucinations; and aggressive, disruptive behavior. The family is utilizing haloperidol as needed to control her behavior. On nursing assessment, you note that the client demonstrates involuntary movements of the tongue and fingers. This may most likely indicate:

1. A. Tardive dyskinesia, which may be a side effect of antipsychotic medication
2. B. Early symptoms of Parkinson??s disease
3. C. A more advanced stage of Alzheimer??s disease than previously experienced by the client
4. D. The need to change her medication from haloperidol to another antipsychotic drug to lessen symptoms

Correct Answer: A
(A) Tardive dyskinesia is a common side effect of antipsychotic medications such as haloperidol. Discontinuing the medication can alleviate symptoms. (B) Although mild tremors are an early sign of Parkinson??s disease, haloperidol must be discontinued first and the client further evaluated. (C) These symptoms do not necessarily indicate a more advanced stage of Alzheimer??s disease. (D) Most antipsychotic drugs are chemically similar and will produce the same side effects.

- (Topic 1)
A 27-year-old man was diagnosed with type I diabetes 3 months ago. Two weeks ago he complained of pain, redness, and tenderness in his right lower leg. He is admitted to the hospital with a slight elevation of temperature and vague complaints of ??not feeling well.?? At 4:30 PM on the day of his admission, his blood glucose level is 50 mg; dinner will be served at 5:00 PM. The best nursing action would be to:

1. A. Give him 3 tbsp of sugar dissolved in 4 oz of grape juice to drink
2. B. Ask him to dissolve three pieces of hard candy in his mouth
3. C. Have him drink 4 oz of orange juice
4. D. Monitor him closely until dinner arrives

Correct Answer: C
(A) The combination of sugar and juice will increase the blood sugar beyond the normal range. (B) Concentrated sweets are not absorbed as fast as juice; consequently, they elevate the blood sugar beyond the normal limit. (C) Four ounces of orange juice will act immediately to raise the blood sugar to a normal level and sustain it for 30 minutes until supper is served. (D) There is an increased potential for the client??s blood sugar to decrease even further, resulting in diabetic coma.

- (Topic 3)
After an infant is delivered by cesarean delivery and placed on the warmer, the RN dries and assesses the infant. At 1 and 5 minutes after birth, the RN does the Apgar scoring of the infant. The RN knows that because this infant was delivered by cesarean section, he is at increased risk for having which one of the following:

1. A. Cold stress
2. B. Cyanosis
3. C. Respiratory distress syndrome
4. D. Seizures

Correct Answer: C
(A) The infant is placed on the warmer and dried after birth. Cold stress occurs when the infant is not dried and kept warm. (B) The fact that this infant was born by cesarean delivery does not place him at a greater risk for cyanosis than an infant delivered vaginally. Cyanosis occurs when infants cannot oxygenate their blood after the umbilical cord is severed. (C) Infants born by cesarean delivery are at a higher risk for developing respiratory distress syndrome because these infants do not pass through the pelvis, where the chest is compressed and fluid is able to escape from the lungs. (D) Cesarean-delivered infants are not at greater risk for seizures than infants delivered vaginally.

- (Topic 5)
A 15-year-old child is admitted to the pediatric unit with a diagnosis of thalassemia. Which of the following would be included in educating the mother and child as part of discharge planning?

1. A. Give oral iron medication every day.
2. B. Have the child??s blood pressure monitored every week.
3. C. Know the signs and symptoms of iron overload.
4. D. Keep exercise at a minimum to reduce stress.

Correct Answer: C
(A) Oral iron supplements are contraindicated in thalassemia. (B) Although heart failure may be an end result of this disease, this action is unnecessary. (C) Iron overload is a potential complication of frequent blood transfusions of children with thalassemia. (D) Children should be encouraged to pursue activities related to their exercise tolerance.

- (Topic 7)
A 40-year-old client has been admitted to the hospital with severe substernal chest pain radiating down his left arm. The nurse caring for the client establishes the following priority nursing diagnosis—Alteration in comfort, pain related to:

1. A. Increased excretion of lactic acid due to myocardial hypoxia
2. B. Increased blood flow through the coronary arteries
3. C. Decreased stimulation of the sympathetic nervous system
4. D. Decreased secretion of catecholamines secondary to anxiety

Correct Answer: A
(A) Anaerobic metabolism results because the decreased blood supply to the myocardium causes a release of lactic acid. Lactic acid is an irritant to the myocardial neural receptors, producing chest pain. (B) Chest pain is caused by a decrease in the O2 supply to the myocardial cells. Treatment modalities for chest pain are aimed toward increasing the blood flow through coronary arteries. (C) Chest pain causes an increase in the stimulation of the sympathetic nervous system. This stimulation increases the heart rate and blood pressure, causing an increase in myocardial workload aggravating the chest pain. (D) Chest pain and anxiety cause increased secretion of catecholamines by stimulating the sympathetic nervous system. This stimulation increases chest pain by increasing the workload of the heart.