NCLEX-RN Practice Quiz Test Bank #9 (75 Questions) NCLEXRN-09-001 Question Tag: room assignments Question Category: Physiological Integrity, Basic Care
... [Show More] and Comfort Which roommate would be mo st suitable for the 6-year-old male with a fractured femur in Russell’s traction? A. 16-year-old female with scoliosis B. 12-year-old male with a fractured femur C. 10-year-old male with sarcoma D. 6-year-old male with osteomyelitis Correct Answer: B. 12-year-old male with a fractured femur The 6-year-old should have a roommate as close to the same age as possible, so the 12-year-old is the best match. A bed is available and the patient gets assigned. There are certain constraints—sex, semi-private versus private, isolation issues, acuity, telemetry and specialty needs. All need to be taken into account to ensure that each patient goes to the right place and receives the proper care. But good capacity management demands that bed assignment be carefully considered and executed. Option A: The client is too old and is female. Bed assignment simply provides the proper location based on specific patient attributes like sex, isolation, telemetry, acuity and specialty needs. Option C: The 10-year-old with sarcoma has cancer and will be treated with chemotherapy that makes him immune suppressed. Bed managers aim at finding an assignment of patients to rooms that strikes a balance between patients’ preferences and comfort on the one hand, and patients’ clinical conditions and the resulting required room facilities on the other. Option D: The 6-year-old with osteomyelitis is infectious. Rooms and beds belong to the critical assets of just any hospital. They account for a considerable part of a hospital’s infrastructure, and a large amount of financial resources are invested in equipping them with medical apparatus to facilitate patient care. Furthermore, they also represent the place where most patients will spend a large part of their stay, as they recover from surgery, wait for examinations to take place, etc. NCLEXRN-09-002 Question Tag: celebrex (Celecoxib) Question Category: Health Promotion and Maintenance A client with osteoarthritis has a prescription for celebrex (Celecoxib). Which instruction should be included in the discharge teaching? A. Take the medication with milk. B. Report chest pain. C. Remain upright after taking for 30 minutes. D. Allow 6 weeks for optimal effects. Correct Answer: B. Report chest pain. Cox II inhibitors have been associated with heart attacks and strokes. Any changes in cardiac status or signs of a stroke should be reported immediately, along with any changes in bowel or bladder habits because bleeding has been linked to use of Cox II inhibitors. Like all NSAIDs, celecoxib carries an FDA boxed warning for cardiovascular risk, including the increased risk of heart attacks and strokes. As a selective COX-2 inhibitor, celecoxib also faces scrutiny for increased cardiovascular risk, since another selective COX-2 inhibitor, rofecoxib, was withdrawn from production in 2004 due to cardiovascular risk concerns. Option A: The medication can be taken with water. Celecoxib is a medication that is taken orally and comes in 50, 100, 200, and 400 mg doses. In rare cases, celecoxib can also be added to customized compounds for topical administration with or without the use of iontophoresis or other topical delivery mechanisms. It is not available via any other route of administration. Option C: The client may remain upright but not necessarily for 30 minutes. Symptoms of celecoxib overdose would likely be similar to overdoses of other NSAIDs, which include lethargy, drowsiness, nausea, vomiting, and epigastric pain. Activated charcoal may be administered for overdose treatment at the discretion of emergency medical providers if the patient presents within 4 hours of known or suspected ingestion of significant amounts of celecoxib. Option D: Allow 6 weeks for optimal effect. In the inpatient setting, as mentioned above, celecoxib is increasingly being used as part of pre-operative and post-operative multimodal pain management algorithms. Research has shown in several small randomized trials that administering celecoxib peri-operatively for elective procedures such as total hip arthroplasties, total knee arthroplasties, and other procedures with some success in reducing pain and improving functionality such as early ambulation. NCLEXRN-09-003 Question Tag: fracture, cast Question Category: Safe and Effective Care Environment,, Safety and Infection Control A client with a fractured tibia has a plaster-of-Paris cast applied to immobilize the fracture. Which action by the nurse indicates an understanding of a plaster-of-Paris cast? The nurse: A. Handles the cast with the fingertips B. Petals the cast C. Dries the cast with a hair dryer D. Allows 24 hours before bearing weight Correct Answer: D. Allows 24 hours before bearing weight A plaster-of-Paris cast takes 24 hours to dry, and the client should not bear weight for 24 hours. After the process of applying the casting material is completed, the material will start to dry in about 10 to 15 minutes. The temperature of the skin might rise as the plaster is drying because of a chemical reaction that occurs. When plaster is used, it can take from 1 to 2 days for the cast to harden completely. Option A: The cast should be handled with the palms, not the fingertips. Use the palm of hand to apply, hold, or move cast and support on pillows after application. Uneven plaster is irritating to the skin and may result in abrasions. Option B: Petaling a cast is covering the end of the cast with cast batting or a sock, to prevent skin irritation and flaking of the skin under the cast. Trim excess plaster from edges of the cast as soon as casting is completed; prevents skin breakdown caused by prolonged moisture trapped under the cast. Option C: The client should be told not to dry the cast with a hair dryer because this causes hot spots and could burn the client. This also causes unequal drying. Promote cast drying by removing bed linen, exposing it to circulating air; pressure can cause ulcerations, necrosis, or nerve palsies. Pad (petal) the edges of the cast with waterproof tape; provides an effective barrier to cast flaking and moisture. Helps prevent the breakdown of cast material at the edges and reduce skin irritation and excoriation. NCLEXRN-09-004 Question Tag: fiberglass cast Question Category: Physiological Integrity, Basic Care and Comfort The teenager with a fiberglass cast asks the nurse if it will be okay to allow his friends to autograph his cast. Which response would be best? A. “It will be alright for your friends to autograph the cast.” B. “Because the cast is made of plaster, autographing can weaken the cast.” C. “If they don’t use chalk to autograph, it is okay.” D. “Autographing or writing on the cast in any form will harm the cast.” Correct Answer: A. “It will be alright for your friends to autograph the cast.” There is no reason that the client’s friends should not be allowed to autograph the cast; it will not harm the cast in any way, so answers B, C, and D are incorrect. Fiberglass has several advantages compared to plaster. It weighs less, so the cast made from it will be lighter. More durable and porous, fiberglass allows air to flow in and out. Fiberglass is the better choice in case the limb must be X-rayed during the healing process. It is also available in a variety of colors. Option B: Plaster costs less than fiberglass and is more malleable (is more easily shaped) than fiberglass in certain cases. Plaster comes in strips or rolls that are moistened and rolled on over the padding. Plaster materials are made from dry muslin that is treated with starch or dextrose and calcium sulfate. Option C: Keep the cast clean and dry. A hair dryer with a cool setting may be used to dry a fiberglass cast if it becomes damp. Call a doctor if the cast does not dry or if the skin under the cast becomes wet. Avoid placing pressure or weight on the cast. If you have a leg injury and have a walking cast, make sure that the cast has hardened completely before you attempt to walk on it. Option D: Like plaster, fiberglass materials come in rolls. Strips are moistened and applied to form the cast. The cast will appear rough after it has dried. Do not place any objects inside the cast. Avoid using lotions or powders on skin underneath the cast. NCLEXRN-09-005 Question Tag: Steinmann pin Question Category: Safe and Effective Care Environment, Management of Care The nurse is assigned to care for the client with a Steinmann pin. During pin care, she notes that the LPN uses sterile gloves and Q-tips to clean the pin. Which action should the nurse take at this time? A. Assisting the LPN with opening sterile packages and peroxide. B. Telling the LPN that clean gloves are allowed. C. Telling the LPN that the registered nurse should perform pin care. D. Asking the LPN to clean the weights and pulleys with peroxide. Correct Answer: A. Assisting the LPN with opening sterile packages and peroxide The nurse is performing the pin care correctly when she uses sterile gloves and Q-tips. All pins and wire sites must be cleaned daily. Basic pin care will be performed once daily by the hospital nursing staff prior to discharge from the hospital. Following discharge, the patient and family will go to the clinic for pin care teaching and instructions. Option B: During pin care, the sterile technique is utilized and sterile gloves are needed. The approach to pin care should occur in a stepwise fashion. If step one is effective there is no need to go further and pins can be wrapped with gauze. If step one is not effective, please continue until effective pin care has been achieved. Option C: A licensed practical nurse can perform pin care. Pin care is recommended during showers, after pool therapy, or swimming in the pool or ocean (ocean saltwater is good for pin sites). Ideally, pin sites are cleaned when the surrounding skin and gauze are soft. This should make removal of gauze and cleaning of pins less painful. Option D: There is no need to clean the weights. The purpose of the cleaning is to prevent the skin from attaching to the pins and wires and to clean and inspect the area to decrease the chance of infection. NCLEXRN-09-006 Question Tag: scoliosis, spica cast Question Category: Physiological Integrity, Reduction of Risk Potential A child with scoliosis has a spica cast applied. Which action specific to the spica cast should be taken? A. Check the bowel sounds B. Assess the blood pressure C. Offer pain medication D. Check for swelling Correct Answer: A. Check the bowel sounds A body cast or spica cast extends from the upper abdomen to the knees or below. Bowel sounds should be checked to ensure that the client is not experiencing a paralytic ileus. Auscultate the abdomen for bowel sounds, if bowel sounds are present, or the patient reports they are passing flatus, clear fluids can commence and aperiments can be administered. Patients must not commence oral fluids if bowel sounds are not present as this finding indicates an ileus. Option B: Checking the blood pressure is a treatment for any client. Routine post anaesthetic observations are a requirement for patient assessment and the recognition of clinical deterioration in post-operative patients; acknowledging that children are at a high risk of complications post anesthetics, surgeries and procedures. Option C: Offering pain medication is inappropriate. Patients who have had a closed reduction usually only require oral analgesia. Patients who have sustained a fracture or who have had open reduction or osteotomy will usually require an opioid infusion and/or epidural. Pain scores, interventions, and evaluation of interventions performed, should be documented in the observation flowsheet. Option D: Checking for swelling isn’t specific to the stem. Evaluate patients’ skin integrity regularly. Observe any redness, irritation or burning sensation. In the acute postoperative period swelling can occur and a tight cast can potentially cause neurovascular compromise. Children who have had an open reduction or osteotomy may have significant swelling in the groin area. Monitor swelling and plaster to ensure the cast is not too tight. NCLEXRN-09-007 Question Tag: fracture, traction Question Category: Safe and Effective Care Environment,, Safety and Infection Control The client with a cervical fracture is placed in traction. Which type of traction will be utilized at the time of discharge? A. Russell’s traction B. Buck’s traction C. Halo traction D. Crutchfield tong traction Correct Answer: C. Halo traction Halo traction will be ordered for the client with a cervical fracture. Halo-gravity traction is a way to pull the head and spine upward carefully, applying a slow stretch to the spine. Doctors do this by attaching a halo (a metal ring that surrounds the head) to a pulley system. Over several weeks, weights are added to the pulley system to slowly pull the head upward. This pulling is called “traction.” Kids stay in the hospital during halo-gravity traction. Option A: According to Oxford Reference, Russell traction is a type of skin traction used to stabilize and align the lower extremities. The patient’s leg is suspended in a sling and attached to pulleys, strings and weights, which serve to gently draw the bones into alignment. Option B: An apparatus for applying longitudinal traction on the leg by contact between the skin and adhesive tape, for maintaining the proper alignment of a leg fracture; friction between the tape and skin permits application of force through a cord over a pulley, suspending a weight; elevation of the foot of the bed allows the body to act as a counterweight; a type of traction in which a non constricting boot with weights is worn by the Pt to maintain proper alignment. Option D: Crutchfield tongs are used while in the hospital and the client is immobile. A traction device whose pins are inserted into the skull to distract and/or immobilize the neck. Crutchfield tongs are used to stabilize fractures of the cervical spine. NCLEXRN-09-008 Question Tag: continuous passive motion device Question Category: Physiological Integrity, Physiological Adaptation A client with a total knee replacement has a CPM (continuous passive motion device) applied during the postoperative period. Which statement made by the nurse indicates an understanding of the CPM machine? A. “Use of the CPM will permit the client to ambulate during the therapy.” B. “The CPM machine controls should be positioned distal to the site.” C. “If the client complains of pain during the therapy, I will turn off the machine and call the doctor.” D. “Use of the CPM machine will alleviate the need for physical therapy after the client is discharged.” Correct Answer: B. “The CPM machine controls should be positioned distal to the site.” The controller for the continuous-passive-motion device should be placed away from the client. Many clients complain of pain while having treatments with the CPM, so they might turn off the machine. The CPM flexes and extends the leg. Continuous passive motion (CPM) is a therapy in which a machine is used to move a joint without the patient having to exert any effort. A motorized device gently bends the joint back and forth to a set number of degrees, and the amount of movement and speed can be adjusted by the physical therapist. CPM machines are most commonly used on knee joints (after some types of knee surgery), but there are versions made for other joints as well. Option A: The client is in the bed during CPM therapy. The use of CPM may begin in the recovery room after surgery or on the day after surgery. Use of the CPM machine may be continuous while you are in the hospital, other than at times when you are receiving other physical therapy or are getting out of bed to use the restroom. Option C: The client will experience pain with the treatment. Recovering normal joint mobility after surgery can be a significant challenge. The stiffness of a joint can be a complication that limits outcomes and causes pain. Because of this, some surgeons use CPM to try to prevent scar tissue formation and improve range of motion. Option D: Use of the CPM does not alleviate the need for physical therapy. It may be recommended after procedures like ACL reconstruction or frozen shoulder surgery, but CPM is most likely to be prescribed after knee replacement or knee cartilage repair surgery. It may also be used after surgery to remove knee tumors in children with osteosarcoma. NCLEXRN-09-009 Question Tag: walker, fracture Question Category: Safe and Effective Care Environment,, Safety and Infection Control A client with a fractured hip is being taught correct use of the walker. The nurse is aware that the correct use of the walker is achieved if the: A. Palms rest lightly on the handles B. Elbows are flexed 0° C. Client walks to the front of the walker D. Client carries the walker Correct Answer: A. Palms rest lightly on the handles The client’s palms should rest lightly on the handles. The elbows should be flexed no more than 30° but should not be extended. Once a model of the walker has been selected, the “fit” of the walker becomes important. When holding on to the walker, the elbows should be bent in a position that feels comfortable and natural. The top of the walker should be even with the crease on the underside of the wrist when the arms are relaxed at the side. Option B: A 0° is not a relaxed angle for the elbows and will not facilitate correct walker use. Walkers that are too low cause the client to stoop over while walking, which impedes proper body mechanics. If the walker is at the wrong height, the client will be prone to aches and pains. Option C: The client should walk to the middle of the walker, not to the front of the walker. To get started, the client should push the walker slightly ahead, then step into the walker. Keep that pattern going—walker slightly ahead, then step into the walker. The walker should never be too far ahead and the client should have excellent posture as he takes steps. Also, the client should not look at feet, rather in front of him. Option D: The client should be taught not to carry the walker because this would not provide stability. If there is trouble gripping the walker, platform walkers are available that may prove to be a better option. The platform allows the client to rest the elbow and forearm, taking stress off the hands. NCLEXRN-09-010 Question Tag: prolapsed cord Question Category: Physiological Integrity, Physiological Adaptation When assessing a laboring client, the nurse finds a prolapsed cord. The nurse should: A. Attempt to replace the cord B. Place the client on her left side C. Elevate the client’s hips D. Cover the cord with a dry, sterile gauze Correct Answer: C. Elevate the client’s hips. The client with a prolapsed cord should be treated by elevating the hips and covering the cord with a moist, sterile saline gauze. The nurse should use her fingers to push up on the presenting part until a cesarean section can be performed. Cesarean section should be performed before rupture of the membrane or the cord would slide down the vagina. Option A: The nurse should not attempt to replace the cord. Assessment of fetal heart sounds is necessary after rupture of membranes to rule out cord prolapse. If there is already complete dilatation, the physician can deliver the baby to prevent fetal anoxia. Option B: The client should not be turned to the side. The goal in therapeutic management is to relieve cord compression to avoid fetal anoxia that can be achieved through manually lifting the head of the fetal head off the cord through the vagina or placing the woman in a Trendelenburg position. Option D: The cord should be covered with a moist, sterile saline gauze. Once the cord has prolapsed and is exposed to air, drying of the umbilical cord and atrophy of the umbilical vessels would begin. Cover any exposed portion of the cord with a sterile saline compress to avoid drying. NCLEXRN-09-011 Question Tag: rosuvastatin Question Category: Physiological Integrity, Pharmacological and Parenteral Therapies The client presents to the clinic with a serum cholesterol of 275 mg/dL and is placed on rosuvastatin (Crestor). Which instruction should be given to the client? A. Report muscle weakness to the physician. B. Allow six months for the drug to take effect. C. Take the medication with fruit juice. D. Ask the doctor to perform a complete blood count before starting the medication. Correct Answer: A. Report muscle weakness to the physician. The client taking antilipidemics should be encouraged to report muscle weakness because this is a sign of rhabdomyolysis. The most common toxic side effect of rosuvastatin is myalgia. If the patient has mild to moderate muscle symptoms, the drug should be discontinued to evaluate for other causes of myalgia. If there is a resolution of the underlying etiology, the patient can restart the original or a lower dose of rosuvastatin; however, if symptoms reoccur for a second time, then discontinue rosuvastatin indefinitely. Switching to a different statin medication at a lower dose may relieve muscle symptoms. Option B: The medication takes effect within 1 month of beginning therapy. Dosing is individualized based on the low-density lipoprotein (LDL) levels at baseline and the goal of therapy. The patient’s response and adherence to medication is an important determinant to therapeutic success. Adjustments should be made at a regular interval of four weeks or more depending on the underlying pathology of the disease and whether the treatment is for primary versus secondary prevention. Option C: The medication should be taken with water because fruit juice, particularly grapefruit, can decrease the effectiveness. The administration of rosuvastatin is via capsule or tablet. The capsule can be administered orally or via a nasogastric tube. The oral route can be taken with or without food, at any time of the day, and should be swallowed whole. The capsule should never be crushed or chewed. If opening the capsule, it is recommended to empty the contents into one teaspoonful of applesauce and then swallow immediately without chewing. Option D: Liver function studies should be checked before beginning the medication, not after the fact, making answer D incorrect. Creatinine phosphokinase (CPK) levels should not be routinely measured; however, the clinician can base special considerations for measuring CPK on family history of statin intolerance, drug-drug interactions leading to increased risk of myopathy, or other clinical presentations that create a high index of suspicion of myopathy. NCLEXRN-09-012 Question Tag: diazoxide, hypertensive crises Question Category: Physiological Integrity, Pharmacological and Parenteral Therapies The client is admitted to the hospital with hypertensive crises. Diazoxide (Hyperstat) is ordered. During administration, the nurse should: A. Utilize an infusion pump B. Check the blood glucose level C. Place the client in Trendelenburg position D. Cover the solution with foil Correct Answer: B. Check the blood glucose level Hyperstat is given as an IV push for hypertensive crises, but it often causes hyperglycemia. The glucose level will drop rapidly when stopped. [Show Less]