NCLEX Questions Exam 1 (N527) 1. The nurse who is reviewing laboratory data for an 89-year-old patient will be most concerned about a: A. platelet count of 380,000/mL. B. hematocrit of 40%. C. white blood cell count (WBC) of 2000/mL. D. hemoglobin of 12.8 g/dL. 2. When caring for a patient with severe iron deficiency anemia, the nurse will assess for: (Select all that apply) A. headache. B. pallor. C. mouth tenderness. D. bradycardia. E. hypertension. F. jaundice. 3. A potential complication of idiopathic aplastic anemia is A. neuropathy B. infection C. vascular edema B. neurogenic shock 4. The complete blood count (CBC) and differential indicate that a client is neutropenic. Which action is a priority and should be included in the plan of care by the nurse? A. Check temperature every 4 hours B. Encourage increased oral fluids C. Avoid all minimally invasive procedures D. Increase intake of iron-rich foods 5. After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? A. 70-year-old who has white pharyngeal lesions B. 52-year-old with frequent urination C. 21-year-old who is complaining of extreme fatigue D. 45-year-old with a fever of 102.8° F (39.3° C) 6. The nurse is preparing a seminar that discusses the risk and incidence of cancer and culture. What information is considered culturally correct when teaching about the risk of developing cancer? A. African Americans are more likely to develop cancer than any other ethnic group. B. Native Americans have the highest incidence of developing colon cancer. C. The Hispanic population has the lowest mortality rate of any racial or ethnic group. D. The incidence and mortality rate of all types of cancers are lowest in the Caucasian population. 7. The nurse has completed a seminar teaching a group in the community about ways to reduce cancer risks. The nurse returns a month later to evaluate the effectiveness of the seminar. Which statements made by members of the group indicate retention and application of the material presented by the nurse to reduce the risk of developing cancer? Select all that apply. A. "I began drinking two glasses of red wine a day with dinner." B. "I started using sunscreen when I work outside." C. "I have increased my intake of fiber." D. "I am trying to quit smoking." E. "I have increased the amount of fried vegetables in my diet." 8. A patient who has vague symptoms of fatigue and headaches is found to have a positive enzyme immunoassay (EIA) for human immunodeficiency virus (HIV) antibodies. In discussing the test results with the patient, the nurse informs the patient that: A. it will probably be 10 or more years before the patient develops acquired immunodeficiency syndrome (AIDS). B. the EIA test will need to be repeated to verify the results. C. the Western blot test will be done to determine whether AIDS has developed. D. a viral culture will be done to determine the progress of the disease. 9. A patient is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and HIV testing is positive. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), the patient is diagnosed as having: A. chronic infection. B. acute infection. C. asymptomatic infection. D. AIDS. 10. Ten years after seroconversion, an HIV-infected patient has a CD4+ cell count of 1000/µl and an undetectable viral load. What is the priority nursing intervention at this time? A. Encourage adequate nutrition, exercise, and sleep. B. Monitor for symptoms of AIDS. C. Discuss likelihood of increased opportunistic infections. D. Teach about the effects of antiretroviral agents. 11. Which hypersensitivity reaction releases enzymes that increase tissue damage? A. Type I B. Type II C. Type III D. Type IV Rationale: Type III reaction occurs when neutrophils attempt to phagocytize the immune complexes, and enzymes are released that increase tissue damage. Type I is triggered when an allergen interacts with IgE, which is bound to mast cells and basophils. A type II reaction is the rupture of cells targeted by the immune response that may affect a variety of organs and tissues. Hemolytic transfusion reaction caused by blood incompatibility is an example. Type IV reaction is an exaggerated interaction between an antigen and the normal cell mediated mechanism. 12. A nurse is teaching foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Remove calluses using over-the-counter remedies. B. Dry feet off including in between toes after bathing. C. Apply lotion between the toes. D. Perform nail care after bathing. E. Trim toenails straight across and round edges. F. Wear socks to protect feet. 13. A nurse is preparing to administer a morning dose of aspart insulin (NovoLog) to a client who has type 1 diabetes mellitus. Which of the following is an appropriate action by the nurse? A. Clarify the prescription because insulin should not be administered at this time. B. Check the client’s blood glucose immediately after breakfast. C. Administer the insulin when breakfast arrives. D. Hold breakfast for 1 hour after insulin administration. 14. A nurse is preparing to administer the morning dose of glargine (Lantus) insulin and regular (Humulin R) insulin to a client who has a blood glucose of 299 mg/dL. Which of the following is an appropriate nursing action? A. Draw up the glargine insulin then the regular insulin in the same syringe. B. Draw up the regular insulin and then the glargine insulin in the same syringe. C. Draw up and administer regular and glargine insulin in separate syringes. D. Administer the glargine insulin, wait 1 hour, and then administer the regular insulin. 15. A nurse is reviewing the clinical manifestations of hyperthyroidism with a client. Which of the following findings should the nurse not include? A. Dry skin: Moist skin is an expected finding for the client who has hyperthyroidism. B. Heat intolerance C. Constipation: Diarrhea is an expected finding for the client with hyperthyroidism. D. Palpitations E. Weight loss F. Bradycardia: Hyperthyroidism increases metabolism and therefore tachycardia is an expected finding. 16. A client being treated for cancer has a tumor designation of Stage IV, T4, N3, M1. What does this staging indicate to the nurse? A. There is one single tumor to treat. B. The tumor will respond to chemotherapy. C. The tumor is small in size. D. The tumor has metastasized with lymph node involvement. Rationale: T refers to the depth of invasion. N refers to the absence or presence and extent of lymph node involvement. M refers to presence of metastasis. The numbers range from 0 to 4, with higher numbers indicating increased size and metastasis. Stage IV indicates metastasis. The staging system is not used to determine tumor response to chemotherapy. 17. The nurse is providing discharge instructions to a client being treated for cancer. For which symptoms should the client be instructed to call for help at home? Select all that apply. A. B. C. D. E. Significant decrease in vomiting Desire to end life Difficulty breathing Improved sense of well-being New onset of bleeding 18. During a treatment meeting on an oncology unit, the nurse learns that a client is scheduled for chemotherapy before and after surgery. What are the purposes for this client to receive chemotherapy at these specific times? Select all that apply. A. Allow the immune system to kill cancer cells. B. Eradicate all cancer cells. C. Kill remaining cancer cells. D. Improve wound healing. E. Shrink the tumor. Rationale: It is impossible to eradicate all cancer cells with chemotherapy. Chemotherapy before surgery is used to shrink the tumor. Chemotherapy is used after surgery to kill remaining cancer cells. The use of chemotherapy before and after surgery will not allow the immune system to kill the cancer cells. Chemotherapy is not used to improve wound healing. 19. A nurse is caring for a client with cancer. The nurse teaches the client about which potentially undesirable cellular alterations that can occur during the cell cycle? Select all that apply. A. Differentiation B. Hyperplasia C. Anaplasia D. Dysphagia E. Adaptation Rationale: Potentially undesirable cellular alterations that can occur during the cell cycle include hyperplasia and anaplasia. Hyperplasia is an increase in the number or density of normal cells, while anaplasia is the regression of a cell to an immature or undifferentiated cell type. Differentiation is a normal process occurring over many cell cycles that allows cells to specialize in certain tasks. Dysphagia and adaptation are not a part of the cell cycle. 20. A client complaining of mouth soreness had gastric bypass surgery 1 year ago. During the assessment, the nurse notes the client's tongue is beefy, red, and smooth and the client's skin appears yellowish. Which additional information is most likely needed before diagnosing this client? A. Vitamin B12 levels B. Vitamin B6 levels C. Vitamin B8 levels D. Iron levels Rationale: Vitamin B12 deficiency is associated with resection of the stomach or ileum. A deficiency of vitamin B12 will result in pernicious anemia. This deficiency will manifest as pallor, jaundice, weakness, and a beefy, smooth red tongue. Iron deficiency anemia will manifest with weakness and fatigue. Vitamin B6 deficiencies are not typically seen with gastric bypass surgeries and are not manifested with a beefy, red, smooth tongue. 21. The nurse instructs a group of community members on the difference between benign and malignant neoplasms. Which participant statements indicate that teaching has been effective? Select all that apply. A. "Benign tumors grow fast." B. "Malignant tumors are difficult to remove." C. "Benign tumors spread to different areas." D. "Malignant tumors invade surrounding tissues." E. "Malignant tumors cannot grow back." 22. The nurse is providing care to a client who was recently diagnosed with breast cancer. The nurse is providing education regarding the possible treatment options. Which options will the nurse include in the teaching session? Select all that apply. A. Mastectomy B. Radiation C. Hormone therapy D. Lumpectomy E. Palliative care Rationale: Treatment options appropriate for a client newly diagnosed with breast cancer may include mastectomy, hormone therapy, lumpectomy, and radiation. Palliative care will only be implemented once the client's cancer is considered to be terminal in nature. 23. The nurse is caring for a client who is undergoing diagnostic tests to rule out lung cancer. The client asks the nurse why a computed tomography (CT) scan was ordered. What is the best response by the nurse? A. "The doctor ordered this test." B. "Why are you concerned about this test?" C. "To rule out the possibility that your problems are caused by asthma." D. "It is more specific in diagnosing your condition." Rationale: Computed tomography (CT) is used to evaluate and localize tumors, particularly tumors in the lung parenchyma and pleura. It also is done before needle biopsy to localize the tumor. In addition, CT scanning can detect distant tumor metastasis and evaluate tumor response to treatment. The client's question is valid and should not be minimized by asking why the client is having concerns about the test. 24. The nurse is speaking with a client who wants information regarding colorectal cancer. Which statement indicates the client understood the information presented by the nurse? A. Colorectal cancer can be detected in early stages by measuring the level of the carcinogenic embryonic antigen (CEA). B. The risk of colorectal cancer increases with age. C. Colorectal cancer has no symptoms in the early stage and there are no definitive diagnostic tests. D. Colorectal cancer occurs more frequently in clients who have a history of inflammatory bowel disease. Rationale: Colorectal cancer is asymptomatic in the early stages. Screening tools such as annual fecal occult blood testing and colonoscopy performed every 10 years can detect the cancer when it is still in the curable stage. Being over age 50 is a risk factor for colorectal cancer. Carcinogenic embryonic antigen (CEA) is not considered a diagnostic test but is used as a tumor marker to follow and manage the disease in clients diagnosed with the disease. The incidence of colorectal cancer is increased in clients with a history of inflammatory bowel disease. 25. A 55-year-old African American female patient with diabetes requests ibuprofen for a headache soon after returning from the bathroom from showering. While in the shower the patient's breakfast tray was removed and the patient did not get to eat. The patient seems to be crabby and diaphoretic as the nurse is helping the patient back into bed. What is the nurse's priority action to take at this time? A. Acknowledge the patient's complaint and offer a peanut butter sandwich before giving the ibuprofen. B. Call the doctor to report an update on the patient's condition. C. Give the patient ibuprofen for the headache and call nutritional services for a new tray. D. Check the patient's blood glucose and be prepared to give the patient 8 ounces of orange juice. 26. A 34-year-old Hispanic male patient with a known history of Diabetes Mellitus arrives to the ED. The nurse assesses the patient and finds the patient is hyperventilating with rapid, deep, and labored breaths with a fruity odor on the breath. Which one of the following nursing interventions is most appropriate for the nurse to perform next? A. Obtain a blood glucose level and check for hypoglycemia and encourage the patient to drink water. B. Obtain a blood glucose level to heck for hyperglycemia and give glucagon by mouth. C. Obtain a blood glucose level to check for hyperglycemia and check the urine for ketones. D. Obtain a blood glucose level to check for hypoglycemia and offer a piece of candy. 27. A twenty-one -year-old patient is 16 hours post-procedure for a thyroidectomy. Which of the following clinical symptoms indicates a possible thyroid storm? A. Blood Pressure of 86/48 and pulse of 58 beats per minute. B. Temperature of 104.8 F and severe restlessness and agitation. C. Wet rales with expiratory wheezing throughout bilateral lung fields. D. Negative Babinski's sign and respirations of 16 breaths per minute. 28. A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to? A. Pheochromocytoma B. Hyperthyroidism C. Thyroid Storm D. Hypothyroidism Explanation: Hypothyroidism...Iodine helps make T3 and T4...if a person does not consume enough iodine, they are at risk for developing hypothyroidism. 29. A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition? A. Weight loss B. Intolerance to heat C. Hair Loss D. Smooth Skin 30. A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition? A. Tapazole B. PTU (Proplthiouracil) C. Synthroid D. Inderal Explanation: Synthroid is the only medication listed that treats hypothyroidism. All other medications are used for hyperthyroidism. 31. You are performing discharge teaching with a patient who is going home on Synthroid. Which statement by the patient causes you to re-educate the patient about this medication? A. "I will take this medication at bedtime with a snack." B. "I will never stop taking the medication abruptly." C. "If I have a palpitation, chest pain, intolerance to heat, or feel restless, I will notify the doctor." D. "I will not take this medication at the same time I take my Carafate." Explanation: Synthroid is best taken in the MORNING on an empty stomach. All the other statements are correct about taking Synthroid. 32. The thyroid hormones, T3 and T4 play many roles in the human body. Which of the following functions are performed by T3 and T4? Select all that apply. A. Storing calories B. Increasing heart rate C. Stimulating the Sympathetic Nervous System D. Decreasing the body's temperature E. Regulating TSH produced by the anterior pituitary gland. Explanation: T3 and T4 burn calories (not store them) and increases body temperature (not decrease). 33. Which of the following laboratory findings would support the diagnosis of hyperthyroidism? A. Increased levels of serum ACTH. B. Increased serum TSH and decreased serum T3 and T4. C. Increased levels of serum TSH. D. Decreased serum TSH and increased serum T3 and T4. 34. A 15-year-old high school student has Type 1 Diabetes they are managing. The student exercises daily by walking as part of their daily routine. However, the student now wants to add biking daily to their exercise regimen. What education would the nurse give the patient to adjust to the increase in exercise? A. The nurse educates the patient to monitor their glucose levels before, during and after the biking to determine changes they need to make. B. The nurse educates the patient to time the morning insulin injection, so the peak action occurs during the biking. C. The nurse educates the patient to add 15 units of regular insulin to their usual morning dose before biking. D. The nurse educates the patient to delay the morning meal until just before biking begins. 35. A male patient with Type II Diabetes Mellitus has a glycosylated hemoglobin (HbA1C) level of 10%. What does this test reveal about the patient's diabetes management? A. The patient has been maintaining an adequate fasting blood glucose level. B. The patient has had elevated glucose levels over the past 3 months. C. The ordered regimen of insulin by the endocrinologist is not enough for the patient's activity level. D. The patient has been compliant with their diet. 36. An African American male patient who receives hemodialysis is prescribed Epoetin alfa, a synthetic version of the renal hormone erythropoietin. When educating the patient about the therapeutic effect of this treatment, which is appropriate for the nurse to include? A. Decrease in platelets B. Increase in white blood cells C. Increase in red blood cells D. Increase in lymph fluid 37. A nurse practitioner (NP) is reviewing a patient's chart by looking at the health history and most recent physical exam. The NP determines the patient is at risk for developing breast cancer. Which data supports the patient's risk factors for breast cancer? Select all that apply. A. Sister had breast cancer B. Age 66 C. Body Mass index 20 D. Menopause at age 57 E. Breastfed all three children Explanation: Age, first-degree relative with breast cancer and menopause after age 55 all increase the risk for breast cancer. 38. A patient with liver cirrhosis begins to leak bright red blood through their nasogastric tube. Which should the nurse prepare to administer to the patient? A. Folic Acid B. Thiamine C. Vitamin B12 D. Platelets Explanation: Platelets along with PRBCs or fresh Frozen plasma are used in an acute bleeding situation to restore blood components and promote hemostasis. 39. An NP is performing a health history on an older female adult patient. Which of the following assessment findings would indicate the patient is at risk for osteoporosis? A. Drinking 32 oz. of skim milk per day B. Having a Body Mass Index (BMI) of 28 C. Using glucocorticoids for 15 years because of COPD D. Eating two to four serving of lobster and liver per week Explanation: Long term use of corticosteroids puts a patient at risk for developing osteoporosis. 40. A patient comes into the ED after experiencing over a week of flu like symptoms, fatigue, poor appetite and chronic pain and discomfort throughout their body. The ED triage nurse assesses the patient and finds a butterfly rash over the bridge of the patient's nose and on the cheeks. Based on this information, which diagnosis best fits the patient's condition? A. Fibromyalgia B. Gout C. Lyme Disease D. Systemic lupus erythematosus Explanation: The butterfly like rash over the bridge of the nose and cheeks is a characteristic of SLE. 41. Which of the following manifestations is associated with systemic lupus erythematosus? Select all that apply. A. Excess hair growth B. Thrombocytopenia C. Symmetric polyarthritis D. Pleural Effusions 42. Which statements about Rheumatoid arthritis (RA) are true? Select all that apply. A. RA is the most common form of autoimmune arthritis. B. RA affects three times as many men as women. C. Typical age of onset is between 40-60 years. D. Affects 1-2% of the world's population. Explanation: RA affects three times more women as men. 43. Anaphylactic reaction to shellfish is which type of hypersensitivity reaction? A. Type I B. Type II C. Type III D. Type IV Explanation: Type I, or immediate hypersensitivity reactions are characterized by rapid development of symptoms after exposure to an antigen. 44. Allergic contact dermatitis is an example of which type of hypersensitivity? A. Type I B. Type II C. Type III D. Type IV Explanation: Type IV is a delayed-type hypersensitivity, reactions involve a major histocompatibility complex and are characterized by tissue damage at the site of antigen contact within 24-48 hours of exposure 45. A transfusion reaction of Rh incompatibility is an example of which hypersensitivity? A. Type I B. Type II C. Type III D. Type IV Explanation: Type II or cytotoxic hypersensitivity reactions involve the rupture of cells targeted by the immune response that may affect a variety of organs and tissues 46. Systemic lupus erythematosus (SLE) is an example of which type of hypersensitivity reaction? A. Type I B. Type II C. Type III D. Type IV Explanation: Type III or immune-complex reactions include inflammatory response in the targeted tissues that leads to tissue damage.