NCLEX Review

1. NCLEX Review Adult Health ~ 52 Selected Lab & Diagnostic Tests Questions Nursing Considerations & Safety Questions and Answers http://usnnursing.pbworks.com/ http://nursing--pharmacology.pbworks.com/

2. 1. A client’s laboratory results reveal a hemoglobin of 6 g/dL. Which foods should be encouraged for this client? • Broiled fish • Whole grains • Dried fruits • Steamed vegetables

3. 1. A client’s laboratory results reveal a hemoglobin of 6 g/dL. Which foods should be encouraged for this client? • Broiled fish • Whole grains • Dried fruits • Steamed vegetables With a low hemoglobin, the oxygen-carrying capacity of the blood is diminished resulting in client fatigue. The preserving agent for dried fruits adds iron, making the fruits excellent sources for this mineral. Normal Hgb range ~ 14-17 g/dl

4. 2. Which nursing diagnosis is most appropriate for a female adult client with a hemoglobin of 12.0 mg/dL and a hematocrit of 29%? • Fluid volume excess • Decreased tissue perfusion • Impaired tissue integrity • Risk for activity intolerance

5. 2. Which nursing diagnosis is most appropriate for a female adult client with a hemoglobin of 12.0 mg/dL and a hematocrit of 29%? • Fluid volume excess • Decreased tissue perfusion • Impaired tissue integrity • Risk for activity intolerance • Hemoglobin is normal. Hematocrit should be 3 times the hemoglobin. If it is less than that, it indicates over hydration or hemodilution. Normal Hgb range ~ 14-17 g/dl Normal Hct ~ 36-50% (males higher than females)

6. 3. The reticulocyte count is elevated in a client with recent blood loss due to severe skin laceration. In planning care, the RN anticipates which physician order? • Maintain fluid intake at 2-3 liters per day • Obtain consent for bone marrow biopsy • Institute iron restricted diet • Prepare client for plasmaphoresis

7. 3. The reticulocyte count is elevated in a client with recent blood loss due to severe skin laceration. In planning care, the RN anticipates which physician order? • Maintain fluid intake at 2-3 liters per day • Obtain consent for bone marrow biopsy • Institute iron restricted diet • Prepare client for plasmaphoresis A. Increased reticulocyte count is normal after blood loss or in anemia. It indicates the bone marrow is working to replace lost RBCs by producing immature RBCs and sending them into the circulation.

8. 4. Which statement would be true of platelets? • Are formed and stored in the spleen • Repair damage to small blood vessels • Cause red blood cells to clump forming clots • Circulate for 4-6 weeks before dying

9. 4. Which statement would be true of platelets? • Are formed and stored in the spleen • Repair damage to small blood vessels • Cause red blood cells to clump forming clots • Circulate for 4-6 weeks before dying • Platelets repair damage to small blood vessels. They are formed in the bone marrow but are stored in the spleen and clump together to form clots. They live 1-2 weeks. Normal count = 150,000-450,000

10. 5. Which is an explanation for a shift-to-the-left in the neutrophil count? • Stem cells are being over produced • Bone marrow is releasing fewer mature cells into the circulating blood • Bone marrow is responding to overproduction of lymphocytes • The thymus gland is unable to produce T-cells

11. 5. Which is an explanation for a shift-to-the-left in the neutrophil count? • Stem cells are being over produced • Bone marrow is releasing fewer mature cells into the circulating blood • Bone marrow is responding to overproduction of lymphocytes • The thymus gland is unable to produce T-cells B. This is the only response related to neutrophil shift-to-the-left.

12. 6. Which of these clients should the nurse assess first? • Hemoglobin level of 15.9 g/dL • Coumadin with a prothrombin time (PT) of 35.6 seconds • Total calcium level of 9.4 mg/dL • BUN of 30 mg/dL and creatinine of 1.1 mg/dL

13. 6. Which of these clients should the nurse assess first? • Hemoglobin level of 15.9 g/dL • Coumadin with a prothrombin time (PT) of 35.6 seconds • Total calcium level of 9.4 mg/dL • BUN of 30 mg/dL and creatinine of 1.1 mg/dL • Normal prothrombin time is <13 seconds and on coumadin therapy, it should be 1.5-2.5 times greater. This client has 3 times greater time and so is at risk. Normal Ca++ ` 9-10.5 mg / dl Normal BUN ~ 7-20 mg / dl Normal Creat ~ 0.5-1.5 mg/dl

14. 7. Which client is most likely to have an elevated erythrocyte sedimentation rate? • Congestive heart failure • Glaucoma • Hypertension • Pregnancy

15. 7. Which client is most likely to have an elevated erythrocyte sedimentation rate? • Congestive heart failure • Glaucoma • Hypertension • Pregnancy • This is the only correct answer. ^ ESR ~ inflammation

16. 8. Which does not specifically increase HDL cholesterol levels? • Smoking cessation • Nicotinic acid • Lipitor (atorvastatin) • Exercise

17. 8. Which does not specifically increase HDL cholesterol levels? • Smoking cessation • Nicotinic acid • Lipitor (atorvastatin) • Exercise C. Lipitor decreases LDL and triglycerides. Stopping smoking, nicotinic acid or niacin, and exercise raise HDL levels.

18. 9. After receiving report of four clients at 7:00 a.m., which task should the nurse complete first? A. Call physician to request antiemetic for client who has been vomiting B. Notify family of a client’s transfer to ICU for chest pain C. Call a potassium level of 5.9 to the attention of the physician D. Begin routine assessment rounds, starting with the sickest client

19. 9. After receiving report of four clients at 7:00 a.m., which task should the nurse complete first? A. Call physician to request antiemetic for client who has been vomiting B. Notify family of a client’s transfer to ICU for chest pain C.Call a potassium level of 5.9 to the attention of the physician D. Begin routine assessment rounds, starting with the sickest client • A potassium level of 5.9 is life threatening. normal serum K+ = 3.5-5.5

20. 10.The nurse is reviewing laboratory test results for a client with severe crush injuries of both lower extremities secondary to a motor vehicle accident. Which result causes the nurse the most concern? A. Blood urea nitrogen of 18 mg/dL B. Serum creatinine level of 1.2 mg/dL C. White blood cell count of 9000/cu mm D. Serum potassium of 6.0 mEq/dL

21. 10.The nurse is reviewing laboratory test results for a client with severe crush injuries of both lower extremities secondary to a motor vehicle accident. Which result causes the nurse the most concern? A. Blood urea nitrogen of 18 mg/dL B. Serum creatinine level of 1.2 mg/dL C. White blood cell count of 9000/cu mm D. Serum potassium of 6.0 mEq/dL • Hyperkalemia can lead to serious cardiac dysrhythmias such as ventricular fibrillation or cardiac standstill. The other lab values are within acceptable parameters. normal serum K+ = 3.5-5.5 Normal WBC Count ~4300 to 10800 Normal BUN ~ 7-20 mg / dl Normal Creat ~ 0.5-1.5 mg/dl

22. 11. A 27-year-old construction worker is admitted to the Urgent Care Center with tachycardia, hypotension, weakness, decreased DTRs, headache, and agitation. The client’s skin is moist and warm, the urine specific gravity is 1.030, and loose stools have occurred. The outside temperature is 98o F (36.67o C) and the client has consumed 1.5 liters of water in the last 30 minutes. What is the most likely cause of the symptoms? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia

23. 11. A 27-year-old construction worker is admitted to the UrgentCare Center with tachycardia, hypotension, weakness, decreased DTRs, headache, and agitation. The client’s skin is moist and warm, the urine specific gravity is 1.030, and loose stools have occurred. The outside temperature is 98o F (36.67o C) and the client has consumed 1.5 liters of water in the last 30 minutes. What is the most likely cause of the symptoms? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia B. With heat, excessive sweating produces sodium and water loss. The water consumed has no electrolytes and the symptoms are consistent with hyponatremia and hypovolemia. Normal SG~ 1.002 and 1.035

24. 12. A client with a calcium level of 12.1 mg/dL is at risk for which problem? • Renal calculi • Osteoporosis • Dental caries • Rickets

25. 12. A client with a calcium level of 12.1 mg/dL is at risk for which problem? • Renal calculi • Osteoporosis • Dental caries • Rickets • This is an elevated level of calcium and may contribute to the formation of kidney stones. Normal Ca++ ` 9-10.5 mg / dl

26. 13. Major trauma to skeletal muscle tissue would not cause an increase in which lab value? A. Alkaline phosphatase B. CK-MM C. LDH D. AST

27. 13. Major trauma to skeletal muscle tissue would not cause an increase in which lab value? A. Alkaline phosphatase B. CK-MM C. LDH D. AST A. Alkaline phosphatase increases with bone trauma. The other values increase with muscle trauma or necrosis.

28. 14. A voided urinalysis result shows numerous epithelial cells, bacteria, and leukocytes, but all other indices are normal. Which intervention is appropriate at this time? • Notify the physician as this indicates an infection • Assess for allergy to antibiotics • Obtain a 2nd urinalysis using a clean-catch method • Perform a catheterized urinalysis

29. 14. A voided urinalysis result shows numerous epithelial cells, bacteria, and leukocytes, but all other indices are normal. Which intervention is appropriate at this time? • Notify the physician as this indicates an infection • Assess for allergy to antibiotics • Obtain a 2nd urinalysis using a clean-catch method • Perform a catheterized urinalysis C. This is most likely a contaminated specimen without proper cleansing before collection.

30. 15. A client is admitted for a cholecystectomy with a creatinine level of 1.0 mg/dL and BUN of 22 mg/dL. Which medication order would the nurse question? • Demerol 50 mg IM every 3-4 hours PRN severe pain • Glucophage (metformin) 500 mg PO every day • Carafate (sucralfate) 1 gm PO qid 1 hour ac and hs • Lopressor (metoprolol) 100 mg PO every day

31. 15. A client is admitted for a cholecystectomy with a creatinine level of 1.0 mg/dL and BUN of 22 mg/dL. Which medication order would the nurse question? • Demerol 50 mg IM every 3-4 hours PRN severe pain • Glucophage (metformin) 500 mg PO every day • Carafate (sucralfate) 1 gm PO qid 1 hour ac and hs • Lopressor (metoprolol) 100 mg PO every day B. Glucophage can lead to liver failure if the client goes into metabolic acidosis (related to renal compromise).

32. 16. The nurse is completing the admission history of a client who is to undergo an intravenous pyelogram (IVP). Which client statement would be cause for concern? • “I received penicillin as a child and it has made me sick ever since.” • “I had a bad experience after eating seafood last year, so I avoid it.” • “My doctor says I shouldn’t eat eggs because they can help clog my arteries.” • “The last time I had a special test, there was a salty taste when they gave me the dye.”

33. 16. The nurse is completing the admission history of a client who is to undergo an intravenous pyelogram (IVP). Which client statement would be cause for concern? • “I received penicillin as a child and it has made me sick ever since.” • “I had a bad experience after eating seafood last year, so I avoid it.” • “My doctor says I shouldn’t eat eggs because they can help clog my arteries.” • “The last time I had a special test, there was a salty taste when they gave me the dye.” Iodine-containing contrast media may be used for the IVP. Many people who are allergic to seafood, are allergic to iodine. If this allergy is present, an anaphylactic reaction can occur during the IVP. ***also, think about oral hypoglycemics…

34. 17. The client asks the nurse about special preparation for an ultrasound of the kidneys. Which response by the nurse is most appropriate? A. “Radiopaque dye will be used to help visualize the kidney.” B. “The puncture site will be monitored frequently for bleeding.” C. “No special preparation is required for this test.” D. “There will be no food or fluid for 12 hours prior to the test.”

35. 17. The client asks the nurse about special preparation for an ultrasound of the kidneys. Which response by the nurse is most appropriate? A. “Radiopaque dye will be used to help visualize the kidney.” B. “The puncture site will be monitored frequently for bleeding.” C. “No special preparation is required for this test.” D. “There will be no food or fluid for 12 hours prior to the test.” C. An ultrasound exam is a noninvasive test that, in most cases, requires no special preparation except a full bladder.

36. 18. A 43-year-old anxious client is to receive teaching prior to a cystoscopy. Which part of the teaching plan indicates the need for clarification prior to talking to the client? • Assess client understanding of the procedure before witnessing the consent form • Teach client that general anesthesia will likely be used • Client may have only clear liquids the evening before the procedure • A bowel prep with laxatives will be completed before the procedure

37. 18. A 43-year-old anxious client is to receive teaching prior to a cystoscopy. Which part of the teaching plan indicates the need for clarification prior to talking to the client? • Assess client understanding of the procedure before witnessing the consent form • Teach client that general anesthesia will likely be used • Client may have only clear liquids the evening before the procedure • A bowel prep with laxatives will be completed before the procedure C. The client may have a light evening meal, then will be NPO after midnight if general anesthesia is used.

38. 19. After cystoscopy, the RN monitors the client for development of post-procedural complications. Which symptom would be most expected? • Urinary frequency and dysuria • Hypertension and polydipsia • Hematuria and hypotension • Orange discoloration to urine and bladder spasm

39. 19. After cystoscopy, the RN monitors the client for development of post-procedural complications. Which symptom would be most expected? • Urinary frequency and dysuria • Hypertension and polydipsia • Hematuria and hypotension • Orange discoloration to urine and bladder spasm A. The most common complication is urinary tract infection due to instrumentation in the procedure.

40. 20. A client with a goiter has a TSH of 0.3 mU/L. The RN would expect which symptoms? • Weight gain, fatigue and bradycardia • Headache, diplopia and tinnitis • Bruit upon auscultation of thyroid and hypertension • Hypernatremia and decreased urine specific gravity

41. 20. A client with a goiter has a TSH of 0.3 mU/L. The RN would expect which symptoms? • Weight gain, fatigue and bradycardia • Headache, diplopia and tinnitis • Bruit upon auscultation of thyroid and hypertension • Hypernatremia and decreased urine specific gravity C. Bruits are often heard with goiter and the hyperthyroidism causes increase in systolic blood pressure and decrease in thyroid stimulating hormone (TSH). A is hypothyroidism. Normal TSH is 0.4-4.2 mU/L.

42. 21. A client with hypothyroidism is on hormone replacement. Which is true concerning abnormal TSH levels? • As the T3 and T4 levels drop, TSH also decreases as a result of the positive feedback loop • After initiation of Synthroid (levothyroxine) the TSH level decreases gradually as a result of the negative feedback loop • Synthroid (levothyroxine) works primarily by converting T3 into T4 and as blood levels rise, TSH levels drop • As the TSH level rises after treatment is started with Synthroid (levothyroxine), calcitonin levels rise and thyroid function normalizes

43. 21. A client with hypothyroidism is on hormone replacement. Which is true concerning abnormal TSH levels? • As the T3 and T4 levels drop, TSH also decreases as a result of the positive feedback loop • After initiation of Synthroid (levothyroxine) the TSH level decreases gradually as a result of the negative feedback loop • Synthroid (levothyroxine) works primarily by converting T3 into T4 and as blood levels rise, TSH levels drop • As the TSH level rises after treatment is started with Synthroid (levothyroxine), calcitonin levels rise and thyroid function normalizes B. This is the only true statement.

44. 22. Which client could have a thyroid scan? • Allergic to shellfish and betadine • 24 weeks pregnant • Breastfeeding a 6 week old baby • Completed steroid treatment 3 weeks ago

45. 22. Which client could have a thyroid scan? • Allergic to shellfish and betadine • 24 weeks pregnant • Breastfeeding a 6 week old baby • Completed steroid treatment 3 weeks ago D. Radioactive iodine may be used 21 days after discontinuing corticosteroids.

46. 23. A 43-year-old obese female client has a fasting blood sugar of 140 mg/dL and states her blood glucose has never been elevated before. Which is the top priority? • Potential for hypoglycemia • Risk for injury related to hyperglycemia • Knowledge deficit related to disease process • Potential for ineffective individual coping

47. 23. A 43-year-old obese female client has a fasting blood sugar of 140 mg/dL and states her blood glucose has never been elevated before. Which is the top priority? • Potential for hypoglycemia • Risk for injury related to hyperglycemia • Knowledge deficit related to disease process • Potential for ineffective individual coping C. Potential problems and risks are secondary priorities. The client has an existing knowledge deficit related to this newly diagnosed diabetes mellitus (FBS>126 mg/dL is diagnostic).

48. 24. A 16-year-old client with type I Diabetes Mellitus is sporadically non-compliant with diet and today’s FBS was 116 mg/dL. Which glycosylated hemoglobin would indicate a need for more teaching? • Hgb A1C is 2.5% • Hgb A1C is 6.5% • Hgb A1C has increased from 5.9% to 7.9% • Hgb A1C has dropped from 4% to 2.5%

49. 24. A 16-year-old client with type I Diabetes Mellitus is sporadically non-compliant with diet and today’s FBS was 116 mg/dL. Which glycosylated hemoglobin would indicate a need for more teaching? • Hgb A1C is 2.5% • Hgb A1C is 6.5% • Hgb A1C has increased from 5.9% to 7.9% • Hgb A1C has dropped from 4% to 2.5% C. Normal Hgb A1C for a diabetic in good control is 6-7%. An increase of 2% and over the normal indicates a need for more teaching.

50. 25. A pregnant client at 28 weeks gestation has a fasting 1 hour glucose challenge test with a result of 156 mg/dL. Which would be the best response by the nurse? • Tell her she has diabetes mellitus and plan teaching • Order a 3 hour glucose tolerance test per protocol • Continue to monitor her as this is normal • Continue to monitor the elevated placental lactogen