75 Nclex Questions No Math Homework

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The NCLEX-PN examination is the National Council Licensure Examination for Licensed Practical Nurses. In the past, a similar examination was referred to as the “State Board” for a nursing license. Passing the NCLEX-PN examination gives your state the authority to grant you a nursing license after the completion of a state approved school for practical nursing.

The content of the NCLEX-PN Test Plan consists of four major sections, each of which test your knowledge, skills and abilities to meet these client needs. These categories, or sections, and the percentage of questions you should expect to see in this examination are:

  1. Safe and Effective Care Environment
    • Coordinated Care (16% to 22%)
    • Safety and Infection Control (10% to16%)
  1. Health Promotion and Maintenance (7% to 13%)
  1. Psychosocial Integrity (8% to 14%)
  1. Physiological Integrity
    • Basic Care and Comfort (7% to 13%)
    • Pharmacological Therapies (11% to 17%)
    • Reduction of Risk Potential (10% to 16%)
    • Physiological Adaptation (7% to 13%)

In addition to the above categories, the questions will also contain ongoing essential themes and skills such as clinical problem solving using the nursing process, communication, caring/compassion, teaching/learning and documentation.

Lastly, most of the questions are multiple choices questions with four items, only one of which is correct. Others are alternative format questions such as choosing all the items where more than one item is correct, fill in the blanks and listing priorities or steps in a procedure from the first to the last. You will see all types of questions in our practice examination for licensed practical nurses.

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1. Select the member of the healthcare team that is paired with one of the main functions of this team member.

  • Occupational therapist: Gait exercises
  • Physical therapist: The provision of assistive devices to facilitate the activities of daily living
  • Speech and language therapist: The treatment of swallowing disorders
  • Case manager: Ordering medications and treatments

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Correct Response: C

Speech and language therapists assess and treat patients with a swallowing disorder; they also assess and treat patients with speech and communication problems as often occurs after a cerebrovascular accident, or stroke. Occupational therapists assist patients with their activities of daily living and they also provide patients with assistive devices to facilitate eating and dressing. Physical therapists perform rehabilitation and restorative care including help with ambulation and balance/gait exercises. Lastly, case managers coordinate care along the continuum of care and they manage insurance reimbursements.

2. The recommended daily caloric intake for sedentary older men, active adult women and children is:

  • 2400 calories
  • 1600 calories
  • 2800 calories
  • 2000 calories

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Correct Response: D

Sedentary older men, active adult women and children should all have 6 ounces of grains, 2½ cups of vegetables, 2 cups of fruits, and 3 cups of milk to help make up their 2000 calorie requirement. Sedentary adolescents require 2400 calories, sedentary women and children require 1600 calories and active adolescents need 2800 calories daily.

3. Ill health, malnutrition, and wasting as a result of chronic disease are all associated with:

  • Surgical asepsis
  • Catabolism
  • Cachexia
  • Venous stasis

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Correct Response: C

Ill health, malnutrition, and wasting as a result of chronic disease are all associated with cachexia. Cachexia can also result from dehiscence of a surgical incision or rupture of wound closure. Surgical asepsis refers to using a sterile technique to protect against infection before, during, and after surgery. The breakdown of tissue, especially after severe trauma or crush injuries is known as catabolism. Venous stasis is a disorder related to pooling of blood in a vein of the body; venous stasis typically occurs in the lower extremities and it is one of the many hazards, or complications, of immobilization.

4. Select all the possible opportunistic infections that adversely affect HIV/AIDS infected patients.

  • Visual losses
  • Kaposi’s sarcoma
  • Wilms’ sarcoma
  • Tuberculosis
  • Peripheral neuropathy
  • Toxoplasma gondii

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Correct Response: B, D, F

Kaposi’s sarcoma, tuberculosis, toxoplasma gondii, mycobacterium avium, herpes simplex, histoplasmosis and salmonella infections are HIV/AIDS associated opportunistic infections. Although many affected patients can experience blindness and peripheral neuropathy, these disorders result from impaired nervous system damage rather than an infection. Lastly, Wilms’ tumor is a pediatric form of kidney cancer and it is neither an infection nor something that typically affects the patient with HIV/AIDS.

5. What can help reduce a patient’s anxiety and postsurgical pain?

  • Preoperative teaching
  • Preoperative checklist
  • Psychological counseling
  • Preoperative medication

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Correct Response: A

Patient teaching before surgery not only helps to reduce a patient’s anxiety and postsurgical pain but it also decreases the amount of anesthesia needed and a lack of anxiety additionally speeds up wound healing. Preoperative checklists are a form of nursing documentation that is used to guide and document the care of the patient before surgery. Psychological counseling is typically NOT necessary except under highly unusual circumstances and preoperative medication can decrease the amount of anesthetic needed and respiratory tract secretions but it does not help with postoperative pain.

6. Which disease decreases the metabolic rate?

  • Cancer
  • Hypothyroidism
  • Chronic obstructive pulmonary disease
  • Cardiac failure

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Correct Response: B

Hypothyroidism causes a decreased metabolic demand, so fewer calories are required. Cancer, chronic obstructive pulmonary disease, or cardiac failure all increase the metabolic demands and the need for added calories.

7. When caring for an infant during cardiac arrest, which pulse must be palpated to determine cardiac function?

  • Carotid
  • Brachial
  • Pedal
  • Radial

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Correct Response: B

The brachial pulse is the most accessible pulse on an infant and, therefore, it is the site of choice. The carotid pulse may be difficult to palpate due to the fatty tissue that typically, and often, surrounds an infant’s neck. Lastly, the radial and pedal pulses may not be reliable indicators of cardiac function.

8. The patient should be sitting when deep breathing and coughing  because this position:

  • Is physically more comfortable for the patient
  • Helps the patient to support their incision with a pillow
  • Loosens respiratory secretions
  • Allows the patient to observe their area and relax

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Correct Response: B

The patient should be sitting when deep breathing and coughing because this position allows the patient to be better able to splint the incision with a pillow which provides abdominal support during coughing. It also allows the lungs to more fully expand because the diaphragm drops. The most comfortable position for the patient is the supine position; however, this position does not permit the lungs to fully expand. There is no association or correlation between loosening respiratory secretions or relaxation with this sitting position.

9. Which procedures necessitate the use of surgical asepsis techniques? Select all that apply.

  • Intramuscular medication administration
  • Central line intravenous medication administration
  • Donning gloves in the operating room
  • Neonatal bathing
  • Foley catheter insertion
  • Emptying a urinary drainage bag

Show Correct Response >>>

Correct Response: B,C,E

Surgical asepsis is used when managing central line intravenous medication administration, when donning sterile gloves in the operating room and when inserting an indwelling Foley catheter. Medical asepsis, or clean technique, is used when bathing a neonate, when emptying a urinary drainage bag and when administering an intramuscular medication injection.

10. What is the ultimate purpose and goal of performance improvement activities?

  • To increase efficiency
  • To contain costs
  • To improve processes
  • To improve policies

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Correct Response: C

The ultimate purpose of quality improvement activities is to identify process flaws and then to change the process so that it is fail proof. Fail proof processes prevent human error and possible patient harm. Although these process improvements and changes may also increase efficiency and decrease costs, the ultimate goal of quality improvement activities is to prevent future occurrences with process changes and not costs and efficiency. Lastly, it is known that processes, not policies, are the root cause of many medical errors.

11. The primary difference between practical nursing licensure and a nursing certification in an area of practice is that nursing licensure is:

  • Insures competency and a nursing certification validates years of experience.
  • Mandated by the American Nurses Association and a nursing certification are not.
  • Is legally mandated by the states and a nursing certification is not.
  • Renewed every two years and a nursing certification is renewed every five years.

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Correct Response: C

The primary difference between practical nursing licensure and a nursing certification in an area of practice is that nursing licensure is legally mandated by the states and NOT the American Nurses Association and a nursing certification is not mandated. To practice nursing without a current and valid license is contrary to the law. Nursing licenses are renewed every two years and nursing certifications are typically renewed every three years, however, this may vary according to the particular certification. Passing the NCLEX examination and receiving a nursing license indicates that the graduate has at least the minimal competency necessary to provide safe patient care. Nursing certifications, on the other hand, validate expertise in a particular area of nursing practice.

12. What intervention is the best to relieve constipation during pregnancy?

  • Increasing the consumption of fruits and vegetables
  • Taking a mild over-the-counter laxative
  • Lying flat on back when sleeping
  • Reduction of iron intake by half or more

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Correct Response: A

Dietary roughage (or fiber) with sufficient fluids and exercise may help relieve constipation. Over-the-counter medications should be avoided during pregnancy. The supine position can place additional pressure on the aorta and vena cava, leading to vena cava syndrome. A reduction of iron supplements during pregnancy may reduce hemoglobin production and result in a less than an effective immune system.

13. You are the LPN working on 2 east with adult medical surgical patients. Your unit has been instructed to perform a horizontal evacuation of your patients because there is a fire on 1 east. Where will you evacuate your patients to?

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Correct Response: C

You would evacuate your patients to west. A horizontal evacuation is the movement of patients to another area of the same floor. A vertical evacuation is the movement of patients to a different floor or level of the building. Patient evacuations are done to prevent patient injury. Under no circumstances should the elevators be used for evacuations.

14. Which electrolyte is essential for enzyme and neurochemical activities?

  • Chloride
  • Magnesium
  • Potassium
  • Phosphate

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Correct Response: B

Magnesium is essential for enzyme and neurochemical activities and it is also needed for cardiac and skeletal muscle excitability. Chloride is the most abundant negatively charged ion in extracellular fluid with potassium being the most abundant positively charge ion. Phosphate assists in acid-base regulation.

15. Number the choices below to reflect the correct sequence for using a fire extinguisher:

  • Aim at the base of the fire
  • Squeeze the handle
  • Sweep back and forth
  • Pull the pin

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Correct Response: D, A, B, C

The correct sequence of action for using a fire extinguished is easily remembered by keeping the PASS acronym in mind. P is pulling out the pin to activate the fire extinguisher; A is to aim the fire extinguisher at the base of the fire; S is to squeeze the handle to discharge the contents of the fire extinguisher; and S is sweep back and forth over the base of the fire while discharging the contents.

16. As you are working you suspect that another licensed practical nurse is verbally and physically abusing a patient. What is the first thing that you will do?

  • Nothing because you are not certain that it is occurring
  • Nothing because you only suspect the abuse
  • Call the police or the security department
  • Report your suspicions to the charge nurse

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Correct Response: D

Nurses and other healthcare providers are mandated by law to report all suspected abuse and neglect. You do NOT have to be certain about it; an expert will perform the investigation. You do not contact the police or the security department; the charge nurse will follow established procedures for notifications not the licensed practical nurse.

17. Which of the following is the World Health Organization’s (WHO) definition of health?

  • The absence of all illness and disease
  • The absence of any comorbidities
  • A holistic state of wellbeing
  • A use of health promotion activities

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Correct Response: C

The World Health Organization (WHO) defines health as a holistic (wholistic) state of wellbeing. This state of wellbeing is far more than the absence of illness, diseases and comorbidities. Lastly, the use of health promotion activities does promote health but these activities do not define health according to the World Health Organization.

18. Which nursing theorist believes that most patients are capable of performing self care?

  • Dorothea Orem
  • Madeleine Leininger
  • Martha Rogers
  • Sister Callista Roy

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Correct Response: A

Dorothea Orem developed the Self Care theory or model. This theory maintains that some patients are completely compensatory and totally dependent on the nurse for care, other patients are partially compensatory and need only assistance by the nurse and others are totally independent in terms of their self care needs. Madeleine Leininger developed the Transcultural Nursing theory; Martha Rogers developed the Science of Unitary Human Beings theory and Sister Callista Roy developed the Adaptation theory of nursing practice.

19. What element is minimally assessed during a basic prenatal physical examination?

  • Palpation and auscultation of the abdomen
  • Examination of the anus and rectum
  • Urinalysis for glucose, protein and ketones
  • Visual assessment of cervix and vagina

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Correct Response: C

A urinalysis is considered routine during the prenatal examination. Assessment of the cervix, vagina, anus, rectum, and palpation and auscultation of the abdomen may not be checked until a complete gynecologic examination is done by the doctor.

20. A positive over-the-counter pregnancy test is considered a:

  • Possible sign of pregnancy.
  • Presumptive sign of pregnancy.
  • Probable sign of pregnancy.
  • Positive sign of pregnancy.

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Correct Response: C

A positive pregnancy test and changes in the reproductive organs are both considered probable signs of pregnancy. Presumptive signs include amenorrhea, frequent urination and pigment changes in skin. Determining the estimated day of birth or delivery (EDB or EDD) is considered to be a positive sign of pregnancy.

21. Select all of the signs and symptoms of hyperthyroidism.

  • Cool skin
  • Thickened bodily hair
  • Heat intolerance
  • Constipation
  • Insomnia
  • Increased appetite
  • Palpitations

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Correct Response: C,E,F,G

The signs and symptoms of hyperthyroidism include heat intolerance, increased appetite, palpitations and insomnia among others such as thinning hair, the loss of hair, increased sweating, weight loss, emotional instability and diarrhea.

22. During which phase of the nursing process does data get collected and validated with the patient and/or family members by the nurse?

  • The implementation phase
  • The assessment phase
  • The evaluation phase
  • The planning phase

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Correct Response: B

Subjective, objective, primary and secondary data is collected and validated with the patient and/or family members by the nurse during the assessment phase of the nursing process. The implementation phase is the actual care of the patient; the evaluation phase includes the comparison of current data to expected outcomes to determine if the patient has achieved the pre-established goals and the planning phase consists of priority setting and care planning.

23. Which of the following is the best worded expected outcome?

  • “The nurse will provide for adequate hydration”
  • “The nurse will insure that the patient is safe”
  • “The patient will cough and deep breathe every two hours”
  • “The patient will value health”

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Correct Response: C

“The patient will cough and deep breathe every two hours” is the best worded expected patient outcome. This outcome or goal is specific, measurable, achievable, realistic, within a specified timeframe, trackable and it should be agreed to by the patient. All expected outcomes are worded in terms of what the patient, not the nurse, will do and it should also be specific and measurable. “The patient will value health” is not measurable.

24. What is a major difference between a problem oriented medical record and a source oriented medical record?

  • The problem oriented medical system has a centralized part of the chart for interdisciplinary progress notes and the source oriented medical record has separate areas for each profession’s progress notes.
  • The problem oriented medical system consists of narrative progress notes and the source oriented medical record uses SOAP.
  • The source oriented medical system uses charting by exception and the source oriented medical record system does not.
  • The source oriented medical system has a centralized part of the chart for interdisciplinary progress notes and the problem oriented medical record has separate areas for each profession’s progress notes.

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Correct Response: A

The problem oriented medical system has a centralized part of the chart for interdisciplinary SOAP progress notes and the source oriented medical record has separate areas for each profession’s progress notes. Although source oriented medical records can use SOAP, this is not a defining characteristic and most of these notes are free formed narrative notes. Charting by exception is a distinctly different medical system than source or problem oriented medical systems.

25. Which of the following are necessary elements of malpractice? Select all that apply.

  • A breach of duty
  • An intentional act
  • A nonintentional act
  • Forseeability
  • Patient harm
  • Causation

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Correct Response: A,D,E,F

The necessary elements of malpractice are a duty to the patient, a breach of duty, foreseeability, causation, and patient harm. The breach of duty can be intentional or nonintentional.

26. Select the following fire emergency interventions in correct sequential order.

  • Pull the fire alarm.
  • Contain the fire.
  • Rescue patients in danger.
  • Extinguish the fire.

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Correct Response: C,A,B,D

The RACE acronym is used to prioritize and sequence the steps that must be followed when a fire occurs. R stands for rescue patients; A is pulling the fire alarm; C is to contain the fire by closing doors, etc.; and E is extinguishing the fire with a fire extinguisher when possible.

27. After your patient has been told that they have Cushing’s syndrome, the patient asks you what Cushing’s syndrome is. How would you respond to this patient’s question?

  • “Cushing’s syndrome is a type of irritable bowel syndrome.”
  • “Cushing’s syndrome is a disorder of the adrenal gland.”
  • “Cushing’s syndrome often occurs among patients who are getting radiation therapy.”
  • “Cushing’s syndrome often occurs among patients who are chemotherapy.”

Show Correct Response >>>

Correct Response: B

Cushing’s syndrome is a disorder of the adrenal gland. It results from the chronic hypersecretion of glucocorticoids from the adrenal cortex. It is Crohn’s disease, not Cushing’s syndrome, that is a type of irritable bowel syndrome and, there is no relationship between Cushing’s syndrome and radiation or chemotherapy.

28. You are preparing a sterile field for a operating room surgical procedure. When should you stop the preparation of this sterile field?

  • When you have placed a sterile item only 1 inch and not 2 inches from the edge of the sterile field
  • When you have completely finished the field. You cannot stop the set up until it is all done.
  • When you have accidentally poured a sterile liquid into a container that was on the sterile field
  • When you turn your upper body only away from the field because the surgeon calls your name

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Correct Response: D

You must stop the preparation of the sterile field and begin all over again when you have turned your upper body away from the field because sterile technique has been violated and the sterility of the field has been broken even when on turns away from the sterile field even for a second. Sterile items must be placed within one inch, not two inches from the edge of the sterile field. Lastly, sterile solutions can be poured into sterile containers on the sterile field without breaking the techniques required according to surgical asepsis.

29. Avulsed teeth should be placed in:

  • Normal saline.
  • Cold water.
  • Milk.
  • Warm water.

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Correct Response: C

Avulsed teeth should be immediately placed in milk. An avulsed tooth is the traumatic loss of a tooth. In addition to placing the tooth in milk, the tooth should only be handled at the crown and not the root of the tooth. These interventions preserve the tooth for reimplantation.

30. You are working in a pediatric unit of the hospital and caring for a six year old boy who is hospitalized with cystic fibrosis and respiratory compromise. Which developmental task is the challenge for this boy at his age?

  • To cough, deep breathe and improve respiratory status
  • To establish industry and self confidence
  • To develop autonomy and self control
  • To develop initiative and a sense of purpose

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Correct Response: D

According to Erik Erikson, a developmental psychologist, the preschool child is challenged with initiative, the development of confidence and a sense of purpose. The other age groups along the life span and their developmental tasks are listed below:

Infant: Trust
Toddler: Autonomy, self control and will power
School Age Child: Industry, self-confidence and competency
Adolescent: Identity formation and a sense of self
Young Adult: Intimacy, affection and love
Middle Aged Adult: Generativity, productivity and concern about others
Older Adults: Ego integrity, wisdom and satisfaction with life

31. The embryonic period during pregnancy takes place from:

  • Weeks 1 to 12.
  • Weeks 1 to 10.
  • Weeks 3 to 5.
  • Weeks 6 to 10.

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Correct Response: D

The embryonic period begins around week 6, following the ovulation period of weeks 1 to 2 and the cell division and implantation period from weeks 3 to 5. The first trimester runs from week 1 until week 12.

32. Place these human needs in order from the greatest priority to the least priority using # 1 as the greatest priority and # 5 as the least of all in terms of priority.

  • Self esteem and esteem by others
  • Self actualization
  • Psychological needs
  • Love and belonging
  • Physiological needs

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Correct Response: E,C,D,A,B

According to Abraham Maslow, the hierarchy of human needs from the most basic and necessary to the least priority are the physiological or biological needs, the safety and psychological needs, the need for love and belonging, self esteem and the esteem by others and self actualization. Maslow’s theory states that until the most basic priority needs are satisfied in a step wise manner, the less priority needs cannot be addressed and fulfilled.

33. During which week does the fetal heart begin pumping its own blood?

  • 3rd week
  • 5th week
  • 9th week
  • 6th week

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Correct Response: A

The embryonic heart begins pumping its own blood, often a different blood type than the mother’s, during week 3. Week 5 includes the development of eyes, legs, and hands. Brain waves become detectable during week 6 and teeth begin to develop during week 9 of gestation.

34. Which of the following is a vector of infection?

  • A contaminated ball
  • A contaminated thermometer
  • An infected person
  • An infectious fly

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Correct Response: D

An infectious fly is an example of a vector that can transmit infection. Other vectors, or nonhuman living beings that can transmit infections to humans, include mice, vermin and mosquitoes. Inanimate items that can spread infection by contact are referred to as fomites. Examples of fomites include a contaminated thermometer, balls and door knobs. An infected human being is a host according to the chain of infection and not a vector.

35. Which oral disorder appears as yellow or white spots on the oral mucosa that are not possible to scrape off without bleeding?

  • Herpes simplex
  • Candidiasis
  • Alphthous ulcers
  • Leukoplakia

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Correct Response: B

Oral candidiasis is characterized with yellow or white spots on the oral mucosa that are not possible to scrape off without bleeding, therefore, no attempts to remove these spots should be done. Herpes simplex is marked with tingling and burning of the lips and mouth areas as well as blisters and a sore throat. Alphthous ulcers, or canker sores, are sore oral lesions; and oral leukoplakia leads to thickened, white patches on the cheeks, tongue, lower lip, or on the floor of the mouth.

36. Which type of cancer has the poorest prognosis?

  • Squamous cell carcinoma
  • Breast cancer
  • Pancreatic cancer
  • Gastric cancer

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Correct Response: C

Of all of the above types of cancer, it is pancreatic cancer that has the poorest prognosis. This is based on the fact that pancreatic cancer is not symptomatic, and therefore, it is diagnosed after the point when a surgical removal can be performed. It has a rapid course and it is characterized with a high degree of mortality.

37. States throughout our nation vary somewhat in terms of things that nursing assistants can and cannot legally do. Which statements about these state to state differences are accurate? Select all that apply.

  • Nursing assistants can change catheter tubings but not catheters
  • Nursing assistants can change sterile dressings
  • Nursing assistants have an expanding role in many states.
  • Nursing assistants cannot assess the physical status of the patients.
  • Nursing assistants can apply topical medication lotions to intact skin.
  • The trend is moving toward nurses only staffing patterns.

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Correct Response: C,D

Nursing assistants have an expanding role in many states. For example, some states permit nursing assistants to take ECGs, or EKGs, and to perform phlebotomy when they are given the necessary training and have been deemed competent to do so. Only nurses assess; nursing assistants cannot assess the physical status of the patients.

Nursing assistants cannot perform any sterile procedures. For example, they cannot change catheter tubings and they cannot change sterile dressings. Lastly, nursing assistants do not administer medications. Topical skin lotions that contain a medication is considered a medication, therefore, the nursing assistant cannot apply them.

38. A cesarean mode of delivery, often utilized for various reasons, is the most common mode for females with which pelvic type?

  • Android
  • Anthropoid
  • Gynecoid
  • Platypelloid

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Correct Response: A

Android pelvic types are heart shaped and found among 23% of all women. Gynecoids are round pelvic types and the most common type at about 50%. Oval shaped pelvic types are anthropoid and found at a rate of 24%. Platypelloids are flat and the least common pelvic type at 3%.

39. How many bones make up a newborn’s skull?

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Correct Response: D

The typical newborns skull will consist of two frontal bones, two parietal bones, and an occipital bone for 5 total bones. Sutures divide these bones and there are 6 fontanelles, or soft spots, where the sutures intersect one another.

40. Your patient has just returned from the diagnostic imaging department and the doctor has told the patient that they have a Mallory-Weiss tear. The patient asks you what a Mallory-Weiss tear is. How should you respond to this patient?

  • “A Mallory-Weiss tear is a kind of diverticulitis.”
  • “A Mallory-Weiss tear is an esophageal tear”
  • “A Mallory-Weiss tear is a lacrimal gland disorder.”
  • “A Mallory-Weiss tear is a tear that results from a peptic ulcer.”

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Correct Response: B

A Mallory-Weiss tear is an linear tear of the esophageal mucosa. Alcohol use and abuse are the most commonly occurring risk factors. These tears are not associated with peptic ulcers or diverticulitis. The lacrimal glands in the eyes produce tears to lubricate the eyes.

41. You have been asked to speak at a new nursing assistants' orientation class about infection control and handwashing techniques. What would you include in this teaching?

  • Demonstrate the correct one minute handwashing procedure using soap and running water.
  • Demonstrate the correct 2 minute handwashing procedure using soap and running water.
  • Using hot water so that the natural fats on the skins are emulsified with the soap.
  • Using cold water so that the natural fats on the skins are emulsified with the soap.

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Correct Response: B

The best way to teach the techniques of handwashing is to actually demonstrate the correct handwashing procedure. Proper handwashing must be done for a minimum of two minutes. Warm not cold water or hot water is used for handwashing.

42. How many minims are contained in 1 milliliter?

  • Between 10-11
  • 12
  • 20
  • Between 15 or 16

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Correct Response: D

A minim is 1480 of a fluid ounce or .0020833333333333 oz. 1 milliliter equals .033814 ounces.

43. Periwound maceration occurs when:

  • The skin around the wound softens and is damaged.
  • Selecting a dressing individualized to the type of wound.
  • Negative-pressure to “air out” the wound is used.
  • The skin around the wound dries out and hardens.

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Correct Response: A

Periwound maceration, also classified as moisture associated skin damage, is the softening of the skin and damaging of connective fibers which leads to the wound drying out and hardening. Dressing selection can help prevent this complication, and negative pressure may reduce it by reducing edema.

44. Which patient is at greatest risk for cholelithiasis and choledocholithiasis?

  • A 70 year old male patient who has liver disease
  • A 70 year old female patient who has liver disease
  • A 50 year old male patient who is Asian
  • A 50 year old female patient who is Asian

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Correct Response: B

The 70 year old female patient who has liver disease is at the greatest risk because the female gender, advancing age and the liver disease are known risk factors for cholelithiasis and choledocholithiasis. Other risk factors include obesity, oral contraceptive use, diseases and disorders of the ileum, hypercholesterolemia and races like the Hispanic, Native American and Caucasian races.

45. Select the method of special precautions that is accurately paired with the personal protective equipment that is minimally required in order to prevent the spread of infection.

  • Contact precautions: Gowns, gloves and mask
  • Droplet precautions: Face mask
  • Airborne transmission precautions: Negative pressure room
  • Contact precautions: Gloves

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Correct Response: B

The minimal personal protective equipment that is required for droplet precautions is a face mask. Contact precautions minimally require the use of gloves and gowns; and airborne transmission precautions minimally require the use of a negative pressure room, a HEPA mask, gowns and gloves.

46. Which statement about Meniere’s disease is accurate and true?

  • Meniere’s disease most commonly occurs among members of the elderly population.
  • Meniere’s disease is insidious and it always affects both ears.
  • Meniere’s disease occurs with an impairment of the second cranial nerve.
  • Antiemetic drugs are used for the treatment of patients affected with Meniere’s disease.

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Correct Response: D

Antiemetic drugs as well as other drugs to treat the vertigo, like Antivert, as well as diuretics are used for the treatment of patients affected with Meniere’s disease. Meniere’s disease typically affects only one ear; it is not the result of second cranial nerve damage. Lastly, people in their 40s and 50s are at greater risk for Meniere’s disease and not the elderly.

47. Which of these patients is affected with a healthcare acquired infection?

  • A 18 year old male patient who developed a intravenous line infection two days after insertion
  • A 72 year old male patient who is at risk for infection secondary to AIDS/HIV
  • A 67 year old female patient who was admitted with a urinary tract infection
  • A 5 year old pediatric patient who develops the measles rash 3 days after admission

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Correct Response: A

The 18 year old male patient who developed a intravenous line infection two days after insertion is affected with a healthcare related, or nosocomial, infection. These infections include all infections that occur while the patient is receiving healthcare services. The patient who was admitted with a urinary tract infection and the pediatric patient who develops the measles rash 3 days after admission acquired these infections prior to receiving healthcare services so they are not considered healthcare related, or nosocomial, infections. Lastly, the 72 year old male patient who is at risk for infection secondary to AIDS/HIV has not yet been infected; he is simply at risk for infection.

48. The stages of infection in correct sequential order are:

  • The prodromal, incubation, illness and convalescence stages
  • The incubation, prodromal, illness and convalescence stages
  • The prodromal, primary, secondary and tertiary stages
  • The inflammation, infection and immunity stages

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Correct Response: A

The incubation, prodromal, illness and convalescence stages are the stages of infection in correct sequential order. Inflammation, infection and immunity are commonly used terms in infection control but they are not stages of the infection process. Primary, secondary and tertiary are levels of prevention and not stages of the infection process.

49. What is the single most important thing that nurses do in order to prevent the spread of infection?

  • Applying standard precautions
  • Using personal protective equipment
  • Adhering to the principles of asepsis
  • Handwashing

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Correct Response:

Handwashing is the single, most important thing that nurses, and other healthcare professionals, can do in order to prevent the spread of infection. Applying standard precautions, using personal protective equipment, as indicated, and adhering to the principles of asepsis also prevent the spread of infections; however, handwashing is the single most important thing to prevent the spread of infection.

50. Rh negative maternal blood indicates:

  • An incompatibility in the blood between the mother and fetus.
  • That antibodies in the mother’s blood are attacking her baby’s blood.
  • The mother will require a blood transfusion at the time of delivery.
  • The mother does not have a specific marker on her red blood cells.

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Correct Response: D

The mother’s red blood cells lacking a specific marker indicate that she is Rh negative. However, incompatibility only occurs if the baby is Rh positive and the mother is Rh negative. This is typically not a problem with a first pregnancy, but in a subsequent pregnancy, the incompatibility can cause the antibodies created during the first pregnancy to attack the new fetus’ red blood cells. A blood transfusion would have no effect on this problem.

51. Low birth weight is defined as a newborn’s weight of:

  • 2500 grams or less at birth, regardless of gestational age.
  • 1500 grams or less at birth, regardless of gestational age.
  • 2500 grams or less at birth, according to gestational age.
  • 1500 grams or less at birth, according to gestational age.

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Correct Response: A

Low birth weight (LBW) is considered to be a birth weight of less than 2,500 grams regardless of gestational age. Very low birth weight (VLBW) is less than 1500 grams and extremely low birth weight (ELBW) which is less than 1000 grams. Normal weight for a full term neonate is 2500-4200 grams.

52. You are caring for a neonate who has a cleft palate. You should inform the mother that surgical correction will be done when the infant is:

  • 8 to 12 months of age.
  • 20 to 24 months of age.
  • 16 to 20 months of age.
  • 12 to 16 months of age.

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Correct Response: A

Repairs of cleft palates are typically done before 12 months because this allows for palatal changes associated with normal growth to occur. While repairs can still be performed after one year of age but this increases the likelihood of needing longer-termed treatments and increased risks for poor language development and facial appearance.

53. What percentage of term newborns has a congenital heart disease due to environmental risk factors such as maternal alcoholism or drug ingestion?

  • 2% to 4%
  • 10% to 20%
  • 5% to 10%
  • 7% to 9%

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Correct Response: C

It is estimated that 5% to 10% of term newborns are born with a congenital heart disease due to environmental risk factors such as maternal alcoholism or drug ingestion. This rate is higher in infants born prematurely. Other environmental risk factors include intrauterine rubella exposure, diabetes mellitus and advanced maternal age in addition to genetic factors.

54. Who should document care?

  • The LPNs should document the care that they provided and the care that was given by unlicensed assistive staff.
  • The registered nurse must document all of the care that is provided by the nursing assistants because they are accountable for all care.
  • All staff members should document all of the care that they have provided.
  • All staff should document all of the care that they have provided but the registered nurse, as the only independent practitioner, signs it.

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Correct Response: C

All staff members, including unlicensed assistive staff like nursing assistants, document and sign, all of the care that they have personally provided. For example, the nursing assistants will document the vital signs that they have taken; the licensed practical nurses will document all of the treatments and medications that they have given to the patient; and the registered nurse will document nursing diagnoses and assessments that they have completed.

55. Your 54 year old male HIV positive patient has just expired. How should you care for this deceased patient?

  • Bathe the patient but it is no longer necessary to use standard precautions because the patient is deceased.
  • Place the patient in an negative pressure isolated area of the morgue.
  • Double shroud the patient to prevent the spread of infection.
  • Bathe the patient using the same standard precautions you used when he was alive.

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Correct Response: D

You should bathe your patient as part of post mortem care using the same standard precautions that you did when the patient was alive. The patient is still infectious. Similarly, all patients are bathed after death using standard precautions. Double shrouding and an isolation area in the morgue with negative air pressure are not necessary.

56. Select the types of pain that are accurately coupled with an example of it. Select all that are correct.

  • Radicular pain: A broken bone
  • Central neuropathic pain: A spinal cord injury
  • Peripheral neuropathic pain: A fractured leg bone
  • Chronic pain: A stab wound to the chest
  • Nocicetive pain: A laceration
  • Radicular pain: A herniated spinal disc

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Correct Response: B,E,F

A spinal cord injury is an example of an injury that leads to central neuropathic pain; the central nervous system is comprised of the brain and the spinal cord. Lacerations and broken, fractured bones are examples of nociecetive pain and a herniated spinal disc can lead to radicular pain. Stab wound can result in acute, not chronic, pain; and peripheral neuropathic pain can result from carpal tunnel syndrome and post amputation phantom pain.

57. Select the stage of viral hepatitis that is accurately paired with its characteristic(s).

  • The prodromal stage: Jaundice begins
  • The icteric stage: Flu like symptoms occur
  • The preicteric stage: Elevated urine bilirubin levels
  • The posticteric stage: Jaundice and dark urine occurs

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Correct Response: C

During the preicteric stage of viral hepatitis, elevated urine bilirubin levels, nausea, chills, anorexia, fever and mild upper right quadrant pain occur. The icteric stage is marked with pruritis, clay stools, darkened urine and jaundice. The posticteric stage occurs when the patient returns to near normal physical status. There is no prodromal stage of viral hepatitis.

58. Which nursing diagnosis is the most commonly used among patients who are affected with fibromyalgia?

  • Decreased self care in the activities of daily living related to fatigue
  • Impaired mental functioning related to electrolyte imbalances
  • Increased vigilance secondary to electrolyte imbalances
  • At risk for a swallowing disorder related to fibromyalgia

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Correct Response: A

The signs and symptoms of fibromyalgia include widespread aching, muscle stiffness, fatigue and sleep disorders. The degree of fatigue can be so severe that the patient is unable to even perform the activities of daily living. Fibromyalgia, a chronic disorder associated with periods of exacerbation and remission is not associated with a swallowing disorder, hypervigilance, mental functioning alterations or electrolyte imbalances.

59. Alcohol, caffeine, or drugs are high risk factors that all fall under which broad classification of risk factors?

  • Social demographic
  • Environmental
  • Biophysical
  • Psychosocial

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Correct Response: D

Psychosocial risk factors include life style choices like the use or abuse of alcohol, caffeine and illicit drugs in addition to smoking and psychological status. Low income, age, and ethnicity are socialdemographic risk factors. Second hand smoke and air pollution are environmental risk factors; and biophysical risk factors include genetic considerations, nutritional status and disorders such as diabetes.

60. Multifetal pregnancies with triplets occur at a rate of 1 in 8,100 births, but twins occur much more frequently with a rate of:

  • 1 in 85 births.
  • 1 in 5400 births.
  • 1 in 2700 births.
  • 1 in 540 births.

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Correct Response: A

Twins, whether monozygotic or dizygotic, occur at the rate of about 1 in every 85 births. This rate has seen increases due to various reasons, such as the frequency of fertility treatments and women waiting until later in life to have children; older women, defined as over 35 years old, are more likely to carry multiples than younger women.

61. When a woman has miscarried in three or more consecutive pregnancies, it is referred to as which type of spontaneous abortion?

  • Inevitable
  • Missed
  • Habitual
  • Habitual

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Correct Response: C

When a woman has miscarried in three or more consecutive pregnancies, it is referred to as habitual abortions. Habitual abortions are often the result of the additional emotional trauma experienced from multiple miscarries. Inevitable abortions are characterizes with bleeding and dilation of the cervical os. When the fetus dies and growth ends, but remains in utero, it is called a missed abortion. Foul-smelling bleeding, fever, and cramping often occur with a septic abortion which is often the result of severe infections.

62. Your long term care patient has chronic pain and at this point in time the patient needs increasing dosages to adequately control this pain. What is this patient most likely to be affected with?

  • Drug addiction
  • Drug interactions
  • Drug side effects
  • Drug tolerance

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Correct Response: D

Patients with chronic pain are often affected with drug tolerance. Drug tolerance occurs when the patient needs increasing dosages of analgesic medications to adequately control their pain in order to produce the same effect that was produced when the drug was originally begun. Drug addiction, on the other hand, is a constant and compulsive need for a drug even when the use of the drug causes harm to the person. Addiction can occur with or without physical dependence. The need for increasing dosages is not the result of medication side effects or food/drug or drug/drug interactions.

63. The normal sodium level in the body is:

  • 135 to 145 milliequivalents.
  • 3 to 5 milliequivalents.
  • 135 to 145 microequivalents.
  • 3 to 5 microequivalents.

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Correct Response: A

The normal sodium level in the body is from 135 to 145 milliequivalents, not from 135 to 145 microequivalents.

64. Which type of practice is most similar to research based practice?

  • Best practices
  • Evidence based practice
  • Benchmark practices
  • Standard based practice

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Correct Response: B

Evidence-based practice is an approach to patient care that encourages nurses to use the best available evidence, or research, in combination with the individual patient’s circumstances and preferences in clinical practice.  Simply stated, evidence based practice is research based practice. Best practices may or may not be based on sound research; benchmarks are similar to best practices and these benchmarks are used so that nurses can compare their outcomes of care to those of others. Standards of care are guidelines for practice; standards of care and standards of practice are published by the American Nurses Association as well as other professional organizations and associations.

65. Select the ethical principles that are paired with their description. Select all that apply.

  • Justice: Being honest and fair
  • Beneficence: Do no harm
  • Veracity: Treating all patients equally
  • Self determination: Facilitating patient choices
  • Beneficence: Do good
  • Nonmaleficence: Do no harm
  • Self determination: Accountability

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Correct Response: D,E,G

The principle of justice requires us to be fair and just to all. Fidelity is being faithful to one’s promises. By the very nature of the implicit nurse-client relationship, the nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent, scientifically grounded manner while upholding the clients’ choices, desires and innate rights. Beneficence means doing good, it is more than not doing harm. Nonmaleficence is “Do not harm”, as stated in the historical Hippocratic Oath. Patient self determination and autonomy is the ethical principle that supports the patient’s right to make their own choices without coercion or the undue influence of others. Lastly, veracity is truthfulness and being honest with the patients.

66. You are caring for a patient with multiple-trauma. Of all of these injuries and conditions, it the most serious?

  • A deviated trachea
  • Gross deformity of a lower extremity
  • Hematuria
  • Decreased bowel sounds

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Correct Response: A

A deviated trachea is a serious life threatening condition. A deviated trachea is a symptom of tension pneumothorax which can be life threatening. All of the other symptoms will need to be addressed and treated, however, it is the deviated trachea that is the most severe and of the greatest priority.

67. Which statement about appendicitis is accurate and true?

  • Appendicitis is more common among females than males.
  • A high fiber diet is a risk factor associated with appendicitis.
  • Left lower quadrant pain is suggestive of appendicitis.
  • Mc Burney’s point tenderness is suggestive of appendicitis.

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Correct Response: D

Mc Burney’s point tenderness in the right lower quadrant is suggestive of appendicitis. Appendicitis is more common among males than females and those with a high carbohydrate and/or low fiber diet are at risk for this inflammation and infection.

68. Which skin disorder most closely resembles and mimics dandruff?

  • Lice infestation
  • Scabies
  • Dematitis
  • Acne vulgaris

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Correct Response: A

Lice infestation with nits most closely resembles and mimics dandruff. Other signs and symptoms of lice infestation include itching and small, red bumps on the scalp, shoulders and/or neck. Scabies is characterized with itchiness and thin, irregular mite burrow tracks that appear like tiny blisters or bumps on the skin. Dermatitis is evidenced with an itchy rash on swollen, reddened skin. Acne vulgaris appears as blackheads and/or whiteheads, papules, pustules, nodules, and/or cysts.

69. You have just learned that another nurse was fired for taking photographs of patients without their permission using a cell phone and posting them on Face book. This nurse was fired because the nurse has:

  • Violated the law
  • Acted in a negligent manner
  • Not completed the proper documentation
  • Violated an ethical principle

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Correct Response: A

This nurse was fired because the nurse has violated a federal law, namely, the U.S. government’s Health Insurance Portability and Accountability Act (HIPAA). This law protects the patients’ rights to the privacy and confidentiality of all medical information, including written, oral electronic information, and personal identity information like photograph taking unless the client has expressly consented to it in writing. Negligence is failing to do something in the proper manner; this invasion of patient privacy is far more serious than a breach of an ethical principle. Lastly, photographs and Facebook posting should never be done so proper documentation is not required. It is still illegal documented or not.

70. Which of the following differentiates ulcerative colitis from Crohn’s disease?

  • Crohn’s disease primarily affects the left colon and rectum and ulcerative colitis most often affects the right colon and distal ileum.
  • Crohn’s disease presents with shallow ulcerations and ulcerative colitis presents with a cobblestone appearance of the mucosal lining.
  • The extent of involvement is noncontiguous and segmented with Crohn’s disease and it is contiguous and diffuse with ulcerative colitis.
  • Crohn’s disease has primarily mucosal involvement and it is transmural with ulcerative colitis.

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Correct Response: C

The extent of involvement is noncontiguous and segmented with Crohn’s disease; and it is contiguous and diffuse with ulcerative colitis. Other differentiating characteristics include:

The typical area of intestinal involvement is the left colon and rectum for ulcerative colitis and the right colon and distal ileum with Crohn’s disease.

The mucosal appearance has a cobblestone appearance with granulomas with Crohn’s disease; and it appears edematous with shallow ulcerations and superficial bleeding.

The inflammation associated with Crohn’s disease is transmural, and it is mostly mucosal among those with ulcerative colitis.

71. Which atrioventricular heart block is also referred to as Mobitz II?

  • Third-degree atrioventricular heart block
  • Second-degree atrioventricular heart block
  • First-degree atrioventricular heart block
  • Complete heart block

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Correct Response: A

Third-degree atrioventricular heart block is also referred to as Mobitz II; this type of heart block occurs when the AV node impulses are blocked as they try to reach the ventricles. First degree heart block occurs when the AV node impulse is delayed. Second degree heart block, as referred to as Mobitz I and Wenckebach, occurs when there are progressive conduction delays through the AV node that alters the PR and QRS intervals. Complete heart block blocks all atrial impulses to the ventricle.

72. Which preventive measure can be employed to decrease the risk of compartment syndrome?

  • The administration of a potassium sparing diuretic for heart failure
  • A bivalve cast for a skeletal fracture
  • A cerebral diuretic to decease intracranial pressure after a head injury
  • A chest tube to restore normal intrathoracic pressure after a pneumothorax

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Correct Response: B

A bivalve cast, rather than a solid fiberglass or plaster of Paris cast, for a skeletal fracture can prevent limb threatening compartment syndrome. Compartment syndrome results from increased pressure and circulatory constriction because a solid cast does not accommodate post fracture swelling like a bivalve cast does. Compartment syndrome is not related to heart failure, head injuries or pneumothoraxes.

73. Which patient is at greatest risk for papilledema?

  • An elderly patient with cataracts and macular degeneration
  • A male patient with hypothyroidism
  • A male patient with hyperthyroidism
  • An adolescent with a closed head injury

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Correct Response: D

Patients, including adolescents, with a closed head injury is at greatest risk for papilledema because closed head injuries lead to an increase in intracranial pressure which leads to papilledema. Hyperthyroidism is associated with exophthalmos and there is no relationship or positive correlation of macular degeneration and/or cataracts to papilledema.

74. Your patient has been diagnosed with orchititis. What information about this disorder should you inform the patient about?

  • This disorder often occurs as the result of a streptococcus.
  • This disorder can be symptomatically treated with ice.
  • This disorder can be symptomatically treated with heat.
  • This disorder is typically treated with surgery.

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Correct Response: B

The pain associated with orchiditis, an inflammation of the testicles, is symptomatically treated with the application of ice, not heat, to the groin area. It is not treated with surgery. This infection most often occurs as the result of mumps, the paramyxovirus and some sexually transmitted diseases, not streptococcus.

75. Which of the following healthcare providers can legally have access to all, or part, of a patient’s medical record because they have a “need to know”? Select all that apply.

  • Student nurses caring for a particular patient
  • Registered nurses when they are not caring for a particular patient
  • The Vice President for Nursing who is investigating a patient fall
  • Licensed practical nurses caring for a particular patient
  • A quality assurance nurse collecting data for a performance improvement activity

Show Correct Response >>>

Correct Response: A,C,D,E

Medical records are restricted to only those who have a “need to know”. Student nurses caring for a particular patient have the “need to know” so they can properly care for their patient assignment. The Vice President for Nursing, as an administrator, who is investigating a patient fall also has a “need to know” because they are collecting data and information to prevent future falls. Licensed practical nurses caring for a particular patient have the “need to know” so they can provide care to the patient; and the quality assurance nurse has the “need to know” because they are collecting data for a performance improvement activity. No nurse, including registered nurses, are allowed access to all or part of a patient’s medical record unless they have a “need to know” because they are providing either direct or indirect care to the patient.

76. Which cardiac arrhythmia can be either acquired or congenital and can spontaneously disappear on its own or lead to ventricular fibrillation?

  • Wenckebach
  • Premature arterial contractions
  • Torsades de pointes
  • Premature ventricular contractions

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Seasoned with Sage

The Nurse Who Failed the NCLEX 6 Times


Jason Thrift RN, BSN, 4/30/09


So how many times will you take the NCLEX?  Most all of you will surely answer at least once.  But for some of us-those select few who no matter how hard we try just can't excel at a nursing exam-it might be a few more.

I'm fessing up: I did not pass the NCLEX the first time.  I had heard from teachers and nurses alike that the exam could potentially shut off at 75 questions, 240 questions or somewhere in between.  If it shut off at 75, you either passed with flying colors or you failed miserably.  If it shut off at 240, you barely passed or barely failed.  Mine shut off at 75 on the dot.  Two days later I found out that I failed the NCLEX exam.

The days that followed, I was disgusted, disappointed, depressed, and any other "d" verb you can think of.  I seriously wondered, Am I cut out to be a nurse?  Have I just spent all this time in school and still don't know or understand enough to be a nurse? I despaired.

That's when my aunt, who was a nurse, offered a story about a nurse she once knew.  This particular nurse was one of the best she had ever seen as it pertained to the care of patients.  An example to follow, emulate. Someone who understood the dynamics of health care and what it took to be not only a nurse, but one of the best.

Then my aunt laid the bombshell: This nurse had failed the NCLEX SIX TIMES!  Here I was fretting over one bad exam, and this poor nurse had to take it SIX TIMES before she got it right.

That story was motivation enough for me to reconcile my differences with a teacher of mine in college and ask for help.  I can honestly say my time spent with this teacher tutoring me made the difference.  It gave me motivation to strive for a goal that obviously I wasn't able to achieve on my own.  The second time around I was ready. And this time the test went to question 76.  After 120 questions the test ended.

A seemingly infinite two days later I found out I passed!

The best advice I could offer anyone out there who has yet to take this exam isn't fresh; it's as old as the advice your 9th grade geometry teacher gave you: Study your hind end off!  Don't listen to those who tell you how the test was that have taken it, or those who took it years ago and speculate what it might be like today. Expect your case to be unique; expect it to be tough.

So, study hard, set a goal, partner with a tutor, and always remember that nurse who failed six times. Because if she can succeed after that many failures, you can too.



Read more Seasoned with Sage articles

Related: Anxiety, Exam, Failure, Fear, Feelings, Learning, NCLEX, New Nurse Tips, Success



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