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Free NCLEX RN Questions
The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention
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Suggest that the client take warm showers.
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Add baby oil to the client's bath water.
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Apply powder to the client's skin.
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Suggest a hot-water rinse after bathing.
Explanation
Correct Answer B. Add baby oil to the client's bath water.
Explanation:
Clients with hepatitis often develop pruritus due to bile salt accumulation under the skin. The best intervention is to keep the skin moisturized and soothed. Adding baby oil or emollients to bath water prevents dryness, decreases itching, and provides comfort.
Why the other options are incorrect:
A. Suggest that the client take warm showers
Warm water actually increases skin dryness and worsens pruritus.
C. Apply powder to the client’s skin
Powder further dries the skin and may increase irritation and itching.
D. Suggest a hot-water rinse after bathing
Hot water worsens itching by increasing vasodilation and dryness. Cool or tepid water is preferred.
The adult grandchild of a client diagnosed with Parkinson disease tells the nurse about proposed gift ideas for the grandparent's birthday in 2 weeks. The grandchild asks the nurse which idea is best. Which option is the best gift for the nurse to recommend
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Perfume and makeup.
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Hearing aid with batteries.
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Warming tray for food.
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Quilt and soft pillow.
Explanation
Correct Answer C. Warming tray for food.
Explanation:
Clients with Parkinson disease often have bradykinesia and tremors, which make eating meals time-consuming. Food may become cold before they finish eating. A warming tray keeps food warm, allowing the client to eat at their own pace without added frustration or nutritional compromise. This promotes independence, dignity, and adequate intake, making it the most practical and thoughtful gift.
Why the other options are incorrect:
A. Perfume and makeup.
While pleasant, these items do not address the client’s daily needs or challenges. Fine motor tremors may also make makeup application frustrating.
B. Hearing aid with batteries.
Unless the client has a diagnosed hearing impairment, this is not a suitable or practical gift. It does not relate to the needs of Parkinson disease.
D. Quilt and soft pillow.
Comfort items are nice but do not specifically support functional challenges associated with Parkinson disease. They do not improve independence or daily living activities.
A clinic nurse examines a client with a tentative diagnosis of primary Sjögren’s syndrome. Which finding would most likely be associated with this syndrome
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Dry eyes and mouth
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Low back stiffness
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Multiple tender points
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Thickening of the skin
Explanation
Correct Answer A. Dry eyes and mouth
Why this is the correct answer:
Primary Sjögren’s syndrome is an autoimmune disorder characterized by lymphocytic destruction of the exocrine glands—especially lacrimal and salivary glands—leading to keratoconjunctivitis sicca (gritty, burning eyes, reduced tear production) and xerostomia (dry mouth, dysphagia for dry foods, rampant dental caries, parotid enlargement). Vaginal dryness and dry skin are also common. Serologies often include anti-Ro/SSA and anti-La/SSB antibodies, with an elevated risk of non-Hodgkin lymphoma.
Why the other options are incorrect:
B. Low back stiffness
Classically associated with inflammatory spondyloarthropathies such as ankylosing spondylitis (HLA-B27), not primary Sjögren’s.
C. Multiple tender points
This finding typifies fibromyalgia, a chronic pain syndrome with widespread tenderness and normal inflammatory markers, not exocrine gland autoimmunity.
D. Thickening of the skin
Cutaneous thickening and sclerodactyly suggest systemic sclerosis (scleroderma), not Sjögren’s syndrome.
Which medication should be avoided by the client with acute pancreatitis
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Demerol (meperidine)
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Pepcid (famotidine)
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Zantac (ranitidine)
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Duramorph (morphine sulfate)
Explanation
The Correct Answer is D. Duramorph (morphine sulfate)
Morphine sulfate should be avoided in clients with acute pancreatitis because it can cause spasm of the sphincter of Oddi, which increases pancreatic ductal pressure and worsens pain. Safer analgesic options include meperidine (though less commonly used today due to neurotoxicity concerns) or hydromorphone. Effective pain control is crucial in pancreatitis, but agents that increase ductal pressure must be avoided.
Why the other options are incorrect:
A. Demerol (meperidine)
Historically preferred for pancreatitis pain because it does not cause sphincter of Oddi spasm. Although rarely used today due to risk of seizures with long-term use, it is still safer than morphine in this context.
B. Pepcid (famotidine)
Famotidine, an H2 receptor blocker, reduces gastric acid secretion and may help prevent stress ulcers. It does not negatively impact pancreatitis.
C. Zantac (ranitidine)
Ranitidine, another H2 receptor antagonist, also reduces gastric acid secretion and is not contraindicated in pancreatitis.
The elderly client is admitted to the emergency room. Which symptom is the client with a fractured hip most likely to exhibitThe elderly client is admitted to the emergency room. Which symptom is the client with a fractured hip most likely to exhibit
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Pain
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Disalignment
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Cool extremity
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Absence of pedal pulses
Explanation
Correct Answer A. Pain
Explanation:
The most common and expected symptom of a fractured hip is severe pain in the hip or groin area, especially with movement or weight bearing. The affected leg may also appear shortened and externally rotated, but pain is the hallmark symptom.
Why the other options are incorrect:
B. Disalignment
While shortening and external rotation may occur, the most reliable presenting symptom across cases is pain.
C. Cool extremity
A cool extremity suggests vascular compromise, which is not typical in a hip fracture unless there is severe associated trauma.
D. Absence of pedal pulses
Pedal pulses are usually intact in hip fractures. Their absence would indicate a vascular emergency, which is rare in isolated hip fractures.
Four clients are to receive medication. Which client should receive medication first
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A client with an apical pulse of 72 receiving Lanoxin (digoxin) PO daily
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A client with abdominal surgery receiving Phenergan (promethazine) IM every four hours PRN for nausea and vomiting
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A client with labored respirations receiving a stat dose of IV Lasix (furosemide)
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A client with pneumonia receiving Polycillin (ampicillin) IVPB every six hours
Explanation
The Correct Answer is C. A client with labored respirations receiving a stat dose of IV Lasix (furosemide)
A client with labored respirations requires immediate attention because this indicates respiratory distress related to fluid overload (e.g., pulmonary edema, heart failure). IV Lasix is a rapid-acting diuretic that helps reduce preload, decrease pulmonary congestion, and improve breathing. Since airway and breathing are the highest priorities (ABCs), this client must receive their medication first.
Why the other options are incorrect:
A. A client with an apical pulse of 72 receiving Lanoxin (digoxin) PO daily
An apical pulse of 72 is within normal limits, and digoxin administration is not urgent compared to respiratory distress.
B. A client with abdominal surgery receiving Phenergan (promethazine) IM every four hours PRN for nausea and vomiting
Nausea and vomiting need attention, but they are not life-threatening compared to labored respirations.
D. A client with pneumonia receiving Polycillin (ampicillin) IVPB every six hours
Antibiotics are important for infection management, but they are not emergent in the immediate sense compared to acute respiratory distress.
A client has signs of increased intracranial pressure. Which one of the following is an early indicator of deterioration in the client's condition
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Widening pulse pressure
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Decrease in the pulse rate
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Dilated, fixed pupils
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Decrease in level of consciousness
Explanation
Correct Answer D. Decrease in level of consciousness
Why this is the correct answer:
The earliest and most sensitive indicator of increased intracranial pressure (ICP) is a change in the client’s level of consciousness. This occurs because rising ICP decreases cerebral perfusion, leading to early cerebral dysfunction. Subtle signs like confusion, restlessness, or lethargy may be observed before vital sign changes or pupillary abnormalities. Early recognition is critical to prevent further neurological deterioration.
Why the other options are incorrect:
A. Widening pulse pressure
This is part of Cushing’s triad (widened pulse pressure, bradycardia, irregular respirations), which indicates late and severe increased ICP, not an early sign.
B. Decrease in the pulse rate
Bradycardia also appears in Cushing’s triad as a late sign of increased ICP. It suggests significant brainstem pressure, which occurs after earlier changes in LOC.
C. Dilated, fixed pupils
Pupil changes are also a late sign, typically indicating herniation or severe brainstem involvement. By this stage, the client’s condition is already critical.
A client is admitted with sickle cell crises and sequestration. Upon assessing the client, the nurse would expect to find
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Decreased blood pressure
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Moist mucus membranes
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Decreased respirations
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Increased blood pressure
Explanation
The Correct Answer is A. Decreased blood pressure
In a sequestration crisis, large amounts of blood pool in the liver and spleen, leading to hypovolemia and shock. The hallmark assessment finding is decreased blood pressure due to reduced circulating blood volume. This can quickly become life-threatening and requires urgent intervention with fluids and blood transfusion.
Why the other options are incorrect:
B. Moist mucus membranes
In sequestration crisis, hypovolemia usually causes dry mucus membranes, not moist ones.
C. Decreased respirations
Respiratory rate typically increases as a compensatory mechanism for hypoxia and decreased oxygen delivery, not decreases.
D. Increased blood pressure
Blood pressure does not rise in sequestration crisis; instead, it falls due to hypovolemia from blood pooling in organs.
A client with COPD is in respiratory failure. Which of the following results would be the most sensitive indicator that the client requires a mechanical ventilator
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PCO2 58
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SaO2 90
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pH 7.23
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HCO3 30
Explanation
Correct Answer C. pH 7.23
Explanation:
In COPD, chronically elevated PCO2 levels are common, so a PCO2 of 58 mmHg may not by itself indicate the need for mechanical ventilation. The most sensitive indicator of respiratory failure is an acidic blood pH (<7.35) due to uncompensated respiratory acidosis, showing that the body is no longer able to maintain adequate gas exchange. A pH of 7.23 indicates severe acidosis, requiring ventilatory support.
Why the other options are incorrect:
A. PCO2 58
Although elevated (normal 35–45 mmHg), COPD patients often tolerate higher CO2 levels chronically. It is not the most sensitive indicator of impending failure.
B. SaO2 90
This is slightly low (normal >94%), but not immediately life-threatening or as sensitive an indicator as pH.
D. HCO3 30
This is elevated (normal 22–26), reflecting renal compensation for chronic respiratory acidosis. It does not indicate acute ventilatory failure by itself.
Intra-arterial chemotherapy primarily benefits the client by applying greater concentrations of medication directly to the malignant tumor. An additional benefit of intra-arterial chemotherapy is
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Prevention of nausea and vomiting
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Treatment of micro-metastasis
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Eradication of bone pain
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Prevention of therapy-induced anemia
Explanation
Correct Answer B. Treatment of micro-metastasis
Why this is the correct answer:
Intra-arterial chemotherapy delivers high concentrations of the drug directly into the artery supplying the tumor. This approach not only targets the primary tumor but also exposes the surrounding circulation to effective drug levels, which can address microscopic tumor spread (micro-metastasis). This helps reduce the risk of recurrence and enhances the overall effectiveness of cancer treatment while sparing healthy tissues from higher systemic toxicity.
Why the other options are incorrect:
A. Prevention of nausea and vomiting
While targeted delivery may reduce systemic side effects somewhat, intra-arterial chemotherapy does not completely prevent nausea and vomiting since cytotoxic drugs can still circulate systemically. Antiemetic drugs are usually needed.
C. Eradication of bone pain
Bone pain relief is not a direct effect of intra-arterial chemotherapy. Bone pain is generally managed with analgesics, radiation, or bisphosphonates, not chemotherapy administration route.
D. Prevention of therapy-induced anemia
Chemotherapy can suppress bone marrow regardless of the route of administration, so intra-arterial infusion does not prevent therapy-induced anemia. Bone marrow suppression remains a risk.
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