NCLEX-RN Exam Pack Set 11 (75 Questions & Answers Updated 2022)
1. 1. Question
A patient is admitted to the hospital with a diagnosis of primary
... [Show More] hyperparathyroidism. A nurse checking the patient’s lab results would expect which of the following changes in laboratory findings?
o A. Elevated serum calcium
o B. Low serum parathyroid hormone (PTH)
o C. Elevated serum vitamin D
o D. Low urine calcium
• 2. Question
A patient with Addison’s disease asks a nurse for nutrition and diet advice. Which of the following diet modifications is not recommended?
o A. A diet high in grains.
o B. A diet with adequate caloric intake.
o C. A high protein diet.
o D. A restricted sodium diet.
• 3. Question
A patient with a history of diabetes mellitus is in the second postoperative day following cholecystectomy. She has complained of nausea and isn’t able to eat solid foods. The nurse enters the room to find the patient confused and shaky. Which of the following is the most likely explanation for the patient’s symptoms?
o A. Anesthesia reaction
o B. Hyperglycemia
o C. Hypoglycemia
o D. Diabetic ketoacidosis
glycemic control, nature and extent of surgical procedure, and available expertise.
o Option A: An anesthesia reaction would not occur on the second postoperative day. Anesthesia and surgery cause a stereotypical metabolic stress response that could overwhelm homeostatic mechanisms in patients with pre-existing abnormalities of glucose metabolism. The invariant features of the metabolic stress response include release of the catabolic hormones epinephrine, norepinephrine, cortisol, glucagons, and growth hormone and inhibition of insulin secretion and action.
o Option B: Confusion is a late sign of hyperglycemia. Shakiness is not one of its symptoms. The management approach in these categories of patients always includes insulin therapy in combination with dextrose and potassium infusion. Major surgery is defined as one requiring general anesthesia of ?1 h. At a minimum, blood glucose should be monitored before and immediately after surgery in all patients. Those undergoing extensive procedures should have hourly glucose monitoring during and immediately following surgery.
o Option D: Symptoms of DKA include excessive thirst, frequent urination, abdominal pain, fruity-scented breath, confusion, and shortness of breath. However, shakiness is not a sign of DKA. The stress of surgery itself results in metabolic perturbations that alter glucose homeostasis, and persistent hyperglycemia is a risk factor for endothelial dysfunction, postoperative sepsis, impaired wound healing, and cerebral ischemia. The stress response itself may precipitate diabetic crises (diabetic ketoacidosis [DKA].
• 4. Question
A nurse assigned to the emergency department evaluates a patient who underwent fiberoptic colonoscopy 18 hours previously. The patient reports increasing abdominal pain, fever, and chills. Which of the following conditions poses
the most immediate concern?
o A. Bowel perforation
o B. Viral gastroenteritis
o C. Colon cancer
o D. Diverticulitis
Correct Answer: A. Bowel perforation
Bowel perforation is the most serious complication of fiberoptic colonoscopy. Important signs include progressive abdominal pain, fever, chills, and tachycardia, which indicate advancing peritonitis. Bowel perforation results from insult or injury to the mucosa of the bowel wall resulting from a violation of the closed system. This exposes the structures within the peritoneal cavity to gastrointestinal contents. Patients presenting with abdominal pain and distension, especially in the appropriate historical setting, must be evaluated for this entity as delayed diagnosis can be life-threatening due to the risk of developing infections such as peritonitis.
o Option B: Several different viruses including rotavirus, norovirus, adenovirus, and astroviruses account for most cases of acute viral gastroenteritis. Most are transmitted via the fecal-oral route, including contaminated food and water. Transmission has also been shown to occur via fomites, vomitus, and possibly airborne methods. Norovirus is more resistant to chlorine and ethanol inactivation than other viruses. Acute gastroenteritis is defined by loose or watery diarrhea that consists of 3 or more bowel movements in a day. Other symptoms may include nausea, vomiting, fever, or abdominal pain
o Option C: Colon cancer does not cause these symptoms. Tumor location on clinical presentation can be separated on left-sided with more changes in bowel habits and hematochezia, and right-sided with obscured anemia impacting on late stage at diagnosis. The provider should perform a thorough physical examination for signs of ascites, hepatomegaly, and lymphadenopathy.
• 5. Question
A patient is admitted to the same day surgery unit for liver biopsy. Which of the following laboratory tests assesses coagulation? Select all that apply.
o A. Partial thromboplastin time
o B. Prothrombin time
o C. Platelet count
o D. Hemoglobin
o E. Complete Blood Count
o F. White Blood Cell Count
• 6.
o Option B: Prothrombin time (PT) is one of several blood tests routinely used in clinical practice to evaluate the coagulation status of patients. More specifically, PT is used to evaluate the extrinsic and common pathways of coagulation, which would detect deficiencies of factors II, V, VII, and X, and low fibrinogen concent [Show Less]