NEW GENERATION NCLEX QUESTIONS FOR
2023-2024 EXAM
The cardiac nurse is evaluating cardiac markers to determine whether or not their patient's heart has
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suffered from muscle damage. The nurse is aware if damage has occurred, CK-MB levels will be their
highest after how many hours?
A. 3 to 6
B. 1 to 2
C. 48 to 72
D. 18 - ANS-D; CK-MB, or creatine kinase myocardial muscle, levels measure muscle cell death and are at
their highest elevation 18 hours after cardiac muscle damage. CK-MB levels first begin elevating about 3 to
6 hours after a cellular injury or myocardial infarction and stay elevated for about 48 to 72 hours.
The nurse is caring for an assigned client. Which prescription requires clarification based on the laboratory
data? See the exhibit. Select all that apply.
View Exhibit
A. Vancomycin 1-gram IVPB Daily
B. Furosemide 40 mg PO Daily
C. 500 ml of 0.9% Saline IV Bolus x 1
D. Diltiazem XR 120 mg PO Daily
E. Ketorolac 15 mg IV Q 8 hours - ANS-A,B,E; The prescribed vancomycin, furosemide, and ketorolac are all
medications that should be clarified with the PHCP based on the BUN and creatinine being elevated. These
elevations represent renal insufficiency. All three of these medications are nephrotoxic. Vancomycin is an
antibiotic indicated for MRSA infections. Furosemide is used for cardiovascular disorders such as
congestive heart failure, and ketorolac is a non-steroidal anti-inflammatory (NSAID) indicated for mild to
moderate pain.
Where would the nurse expect to assess tympany when performing percussion on a patient with ascites?
A. Sides of abdomen
B. Over the top of the abdomen
C. Below the umbilicus
D. Over the umbilicus - ANS-B; Patients with ascites present with tightly stretched skin over a rounded,
distended abdomen due to accumulation of fluid in the peritoneal cavity typically related to liver disease,
portal hypertension, tuberculosis, or nephritic syndrome. Upon percussion of the abdomen, the nurse
would expect to note tympany over the top of the abdomen where the intestines float, and dullness over the
sides where fluid settles (fluid shifts when the patient is turned to the side).
The nurse is assessing a client with pheochromocytoma. Which of the following would be an expected
finding?
Select all that apply.
A. Hyperglycemia
B. Hypertension
C. Ataxia
D. Oliguria
E. Headache - ANS-A,B,E; Pheochromocytoma is a condition caused by a tumor that sits on the adrenal
medulla. This causes a surge in catecholamine discharge resulting in headaches, palpitations, marked
hypertension, and hyperglycemia. Treatment includes antihypertensives and removal of the tumor. The
client should be educated to avoid sources of caffeine, smoking, and stressful situations, as this would
further increase blood pressure.Pheochromocytoma is a condition caused by a tumor that sits on the
adrenal medulla. This causes a surge in catecholamine discharge resulting in headaches, palpitations,
marked hypertension, and hyperglycemia. Treatment includes antihypertensives and removal of the tumor.
The client should be educated to avoid sources of caffeine, smoking, and stressful situations, as this would
further increase blood pressure.
Clinical Manifestations of Cardiac Tamponade (5) - ANS-Tachycardia, tachypnea, pericardial rub, JVD,
hypotension with a narrowed pulse pressure
Normal Magnesium level - ANS-1.5-2.5 mEq/L
The nurse is teaching a continuing education course regarding vaccines and pregnancy. It would be
appropriate for the nurse to state which vaccines are not recommended to be administered during
pregnancy? Select all that apply.
A. MMR
B. Varicella
C. Hepatitis A
D. Inactivated Influenza
E. TDAP (Tetanus, Diphtheria, Pertussis)
F. Human Papillomavirus (HPV) - ANS-A, B, F
The nurse is teaching a client about the newly prescribed medication, sevelamer. Which statement, if made
by the client, would indicate a correct understanding of the teaching?
A. "This medication will help lower my calcium level."
B. "I should take this medication with my meal."
C. "I may experience bad diarrhea with this medication."
D. "My blood pressure may increase while I take this medication." - ANS-B; Sevelamer is a phosphate binder
that is indicated for individuals with chronic kidney disease (CKD). This medication inhibits phosphorus
absorption, thereby increasing the calcium level. Hyperphosphatemia and hypocalcemia are common
laboratory abnormalities found in CKD. Phosphorus and calcium have a reciprocal relationship; therefore,
lowering phosphorus levels through phosphate binders is a standard treatment for CKD. The nurse should
ensure these medications are given with meals and advise the client to mitigate the common effect of
constipation through stool softeners and laxatives.
The nurse assesses an infant who sustained a traumatic brain injury (TBI). Which assessment finding
requires follow-up?
Select all that apply [Show Less]