NCLEX-PN FINAL EXAM 2021/2022

VERIFIED SOLUTION

1. A 24-year-old female client is scheduled for surgery in the morning. Which of the

following is the primary responsibility of the nurse?

A. Taking the vital signs

B. Obtaining the permit

C. Explaining the procedure

D. Checking the lab work

2. The nurse is working in the emergency room when a client arrives with severe burns of

the left arm, hands, face, and neck. Which action should receive priority?

A. Starting an IV

B. Applying oxygen

C. Obtaining blood gases

D. Medicating the client for pain

3. The nurse is visiting a home health client with osteoporosis. The client has a new

prescription for alendronate (Fosamax). Which instruction should be given to the client?

A. Rest in bed after taking the medication for at least 30 minutes

B. Avoid rapid movements after taking the medication

C. Take the medication with water only

D. Allow at least 1 hour between taking the medicine and taking other medications

4. The nurse is making initial rounds on a client with a C5 fracture and crutchfield tongs.

Which equipment should be kept at the bedside?

A. A pair of forceps

B. A torque wrench

C. A pair of wire cutters

D. A screwdriver

5. An infant weighs 7 pounds at birth. The expected weight by 1 year should be:

A. 10 pounds

B. 12 pounds

C. 18 pounds

D. 21 pounds

6. A client is admitted with a Ewing’s sarcoma. Which symptoms would be expected due to

this tumor’s location?

A. Hemiplegia

B. Aphasia

C. Nausea

D. Bone pain

7. The nurse is caring for a client with epilepsy who is being treated with carbamazepine

(Tegretol). Which laboratory value might indicate a serious side effect of this drug?

A. Uric acid of 5mg/dL

B. Hematocrit of 33%

C. WBC 2,000 per cubic millimeter

D. Platelets 150,000 per cubic millimeter

8. A 6-month-old client is admitted with possible intussuception. Which question during the

nursing history is least helpful in obtaining information regarding this diagnosis?

A. “Tell me about his pain.”

B. “What does his vomit look like?”

C. “Describe his usual diet.”

D. “Have you noticed changes in his abdominal size?”

9. The nurse is assisting a client with diverticulosis to select appropriate foods. Which food

should be avoided?

A. Bran

B. Fresh peaches

C. Cucumber salad

D. Yeast rolls

10. A client has rectal cancer and is scheduled for an abdominal perineal resection. What

should be the priority nursing care during the post-op period?

A. Teaching how to irrigate the illeostomy

B. Stopping electrolyte loss in the incisional area

C. Encouraging a high-fiber diet

D. Facilitating perineal wound drainage

11. The nurse is performing discharge teaching on a client with diverticulitis who has been

placed on a low-roughage diet. Which food would have to be eliminated from this client’s diet?

A. Roasted chicken

B. Noodles

C. Cooked broccoli

D. Custard

12. A client arrives in the emergency room with a possible fractured femur. The nurse should

anticipate an order for:

A. Trendelenburg position

B. Ice to the entire extremity

C. Buck’s traction

D. An abduction pillow

13. A client with cancer is to undergo an intravenous pyelogram. The nurse should:

A. Force fluids 24 hours before the procedure

B. Ask the client to void immediately before the study

C. Hold medication that affects the central nervous system for 12 hours pre- and post-test

D. Cover the client’s reproductive organs with an x-ray shield

14. The nurse is caring for a client with a malignancy. The classification of the primary

tumor is Tis. The nurse should plan care for a tumor:

A. That cannot be assessed

B. That is in situ

C. With increasing lymph node involvement

D. With distant metastasis

15. A client is 2 days post-operative colon resection. After a coughing episode, the client’s

wound eviscerates. Which nursing action is most appropriate?

A. Reinsert the protruding organ and cover with 4×4s

B. Cover the wound with a sterile 4×4 and ABD dressing

C. Cover the wound with a sterile saline-soaked dressing

D. Apply an abdominal binder and manual pressure to the wound

16. The nurse is preparing a client for surgery. Which item is most important to remove

before sending the client to surgery?

A. Hearing aid

B. Contact lenses

C. Wedding ring

D. Artificial eye

17. The nurse on the 3–11 shift is assessing the chart of a client with an abdominal aneurysm

scheduled for surgery in the morning and finds that the consent form has been signed, but the

client is unclear about the surgery and possible complications. Which is the most appropriate

action?

A. Call the surgeon and ask him or her to see the client to clarify the information

B. Explain the procedure and complications to the client

C. Check in the physician’s progress notes to see if understanding has been documented

D. Check with the client’s family to see if they understand the procedure fully

18. The client with diabetes is preparing for discharge. During discharge teaching, the nurse

assesses the client’s ability to care for himself. Which statement made by the client would

indicate a need for follow-up after discharge?

A. “I live by myself.”

B. “I have trouble seeing.”

C. “I have a cat in the house with me.”

D. “I usually drive myself to the doctor.”

19. The client is receiving total parenteral nutrition (TPN). Which lab test should be

evaluated while the client is receiving TPN?

A. Hemoglobin

B. Creatinine

C. Blood glucose

D. White blood cell count

20. The client with a myocardial infarction comes to the nurse’s station stating that he is

ready to go home because there is nothing wrong with him. Which defense mechanism is the

client using?

A. Rationalization

B. Denial

C. Projection

D. Conversion reaction