NCLEX-RN Practice Quiz Test Bank #1 (75 Questions), Exams of Biology

Download NCLEX-RN Practice Quiz Test Bank #1 (75 Questions) and more Exams Biology in PDF only on Docsity! NCLEX-RN Practice Quiz Test Bank #1 (75 Questions) NCLEXRN-01-001 Question Tag: hypertension Question Category: Physiological Integrity, Reduction of Risk Potential Which individual is at greatest risk for developing hypertension?  A. 45-year-old African-American attorney  B. 60-year-old Asian-American shop owner  C. 40-year-old Caucasian nurse  D. 55-year-old Hispanic teacher Correct Answer: A: 45-year-old African American attorney  Option A: African-Americans develop high blood pressure at younger ages than other groups in the US. Researchers have uncovered that African- Americans respond differently to hypertensive drugs than other groups of people. They are also found out to be more sensitive to salt, which increases the risk of developing hypertension.  Option B: The incidence of hypertension in Asian-Americans does not appear to be significantly higher than the general population, according to limited US data.  Option C: The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African-Americans with greater risks than Caucasians.  Option D: Hypertension prevalence rates in Hispanics may vary by gender and country of origin. Hispanic Americans overall have relatively low levels of hypertension, despite elevated levels of diabetes and obesity. NCLEXRN-01-002 Question Tag: acetaminophen Question Category: Physiological Integrity, Pharmacological and Parenteral Therapies A 15-year-old female who ingested 15 tablets of maximum strength acetaminophen 45 minutes ago is rushed to the emergency department. Which of these orders should the nurse do first?  A. Gastric lavage  B. Administer acetylcysteine (Mucomyst) orally  C. Start an IV Dextrose 5% with 0.33% normal saline to keep the vein open  D. Have the patient drink activated charcoal mixed with water Correct Answer: A. Gastric lavage  Option A: Acetaminophen overdose is extremely toxic to the liver causing hepatotoxicity. Early symptoms of hepatic damage include nausea, vomiting, abdominal pain, and diarrhea. If not treated immediately, hepatic necrosis occurs and may lead to death. Removing as much of the drug as possible is the first step in treatment for acetaminophen overdose, this is best done through gastric lavage. Gastric lavage (irrigation) and aspiration consist of flushing the stomach with fluids and then aspirating the fluid back out. This procedure is done in life-threatening cases such as acetaminophen toxicity and only if less than one (1) hour has occurred after ingestion.  Option B: The oral formulation of acetylcysteine is the drug of choice for the treatment of acetaminophen overdose but should be done after GI decontamination with activated charcoal. Liver damage is minimized by giving acetylcysteine (Mucomyst), the antidote for acetaminophen. Acetylcysteine reduces injury by substituting for depleted glutathione in the reaction that converts the toxic metabolite of acetaminophen to its nontoxic form. When given within 8 hours of acetaminophen toxicity, acetylcysteine is effective in preventing severe liver injury. It is administered orally or intravenously.  Option C: Intermittent IV infusion with Dextrose 5% may be considered for late-presenting or chronic ingestion. NCLEXRN-01-005 Question Tag: growth, school age Question Category: Health Promotion and Maintenance What would the nurse expect to see while assessing the growth of children during their school age years?  A. Decreasing amounts of body fat and muscle mass  B. Little change in body appearance from year to year  C. Progressive height increase of 4 inches each year  D. Yearly weight gain of about 5.5 pounds per year Correct Answer: D. Yearly weight gain of about 5.5 pounds per year School age children gain about 5.5 pounds each year and increase about 2 inches in height. Between ages 2 to 10 years, a child will grow at a steady pace.  Option A: Decreasing amounts of body fat and muscle mass are common in toddlers.  Option B: A decrease in the change in body appearance occurs among young adults.  Option C: Growth spurts are common in school-age children, as are periods of slow growth. NCLEXRN-01-006 Question Tag: blood pressure Question Category: Health Promotion and Maintenance At a community health fair, the blood pressure of a 62-year-old client is 160/96 mmHg. The client states “My blood pressure is usually much lower.” The nurse should tell the client to:  A. Go get a blood pressure check within the next 15 minutes  B. Check blood pressure again in two (2) months  C. See the healthcare provider immediately  D. Visit the health care provider within one (1) week for a BP check Correct Answer: A. Go get a blood pressure check within the next 15 minutes. The blood pressure reading is moderately high with the need to have it rechecked after a few minutes to verify. The client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke.  Options B & D: Waiting 2 months or a week for follow-up is too long.  Option C: Immediate check by the provider of care is not warranted. NCLEXRN-01-007 Question Tag: prioritization Question Category: Safe and Effective Care Environment, Safety and Infection Control The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission?  A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and admitted with bacterial pneumonia five days ago.  B. A young adult with diabetes mellitus Type 2 for over ten (10) years and admitted with antibiotic-induced diarrhea 24 hours ago.  C. An elderly client with a history of hypertension, hypercholesterolemia, and lupus, and was admitted with Stevens-Johnson syndrome that morning.  D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago. Correct Answer: A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and admitted with bacterial pneumonia five days ago. The best candidate for discharge is one who has had a chronic condition and is most familiar with their care. This client in option A is most likely stable and could continue medication therapy at home.  Option B: The client with antibiotic-induced diarrhea still needs continuous strict monitoring as the blood sugar levels may become unstable and dehydration is still possible.  Option C: Stevens-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters.  Option D: Cellulitis is often an underestimated complication of HIV disease, but they are responsible for an appreciable morbidity. NCLEXRN-01-008 Question Tag: hypothyroidism, levothyroxine Question Category: Physiological Integrity, Pharmacological and Parenteral Therapies A 25-year-old male client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:  A. Should be taken in the morning  B. May decrease the client’s energy level  C. Must be stored in a dark container  D. Will decrease the client’s heart rate Correct Answer: A. Should be taken in the morning  Option A: Levothyroxine (Synthroid) has a side effect of insomnia. Taking it in the morning could prevent interfering with the client’s sleeping pattern.  Option B: Some of the side effects of Levothyroxine include hyperactivity and increase in heart rate.  Option C: Keep this drug in a cool, dark, and dry place.  Option D: A decrease in the heart rate is a desired effect of Levothyroxine.  Option C & D: Staphylococcus and streptococcus may cause PID but it rarely occurs. NCLEXRN-01-012 Question Tag: prioritization Question Category: Safe and Effective Care Environment, Management of Care A registered nurse who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN?  A. A middle-aged client who says “I took too many diet pills” and “my heart feels like it is racing out of my chest.”  B. A young adult who says “I hear songs from heaven. I need money for beer. I quit drinking two (2) days ago for my family. Why are my arms and legs jerking?”  C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 11,  D. An elderly client who reports having taken a “large crack hit” 10 minutes prior to walking into the emergency room. Correct Answer: C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 10. Nurses who are floated to other units should be assigned to a client who has minimal anticipated immediate complications of their problem. This client exhibits opioid toxicity with the pinpoint pupils and has the least risk of complications to occur in the near future.  Option A: The client in option A might be experiencing an overdose.  Option B: Client in option B is having withdrawal syndrome.  Option D: The client in this option may experience a decrease in sensorium later on due to head trauma. NCLEXRN-01-013 Question Tag: coronary artery disease, nutrition Question Category: Health Promotion and Maintenance When teaching a client with coronary artery disease about nutrition, the nurse should emphasize:  A. Eating three (3) balanced meals a day  B. Adding complex carbohydrates  C. Avoiding very heavy meals  D. Limiting sodium to 7 gms per day Correct Answer: C. Avoiding very heavy meals Eating large, heavy meals can pull blood away from the heart for digestion and is dangerous for the client with coronary artery disease. Too much plaque may accumulate in the arteries and block the delivery of blood and oxygen in major organs of the body.  Option A: Eating a balanced diet should be a part of the management of a client with coronary artery disease.  Option B: Complex carbohydrates decrease inflammation and help decrease the risk of plaque build up in the arteries.  Option C: People with cardiovascular diseases should have a limit of less than 1.5 grams per day. NCLEXRN-01-014 Question Tag: morphine, pain management Question Category: Physiological Integrity, Pharmacological and Parenteral Therapies Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour plus PRN for pain breakthrough for morphine drip is not working?  A. The client complains of discomfort at the IV insertion site  B. The client states “I just can’t get relief from my pain.”  C. The level of drug is 100 ml at 8 AM and is 80 ml at noon  D. The level of the drug is 100 ml at 8 AM and is 50 ml at noon Correct Answer: C. The level of the drug is 100 ml at 8 AM and is 80 ml at noon The minimal dose of 10 mL per hour which would be 40 mL given in a four (4) hour period. Only 60 mL should be left at noon. The pump is not functioning when more than expected medicine is left in the container.  Option A: Discomfort at the IV insertion site may indicate inflammation or infection of the site.  Option B: Morphine is a strong painkiller indicated for severe pain.  Option D: The pump is working correctly if there is only 50 ml left at noon. NCLEXRN-01-015 Question Tag: health promotion, chiropractic treatment Question Category: Health Promotion and Maintenance The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse’s response?  A. Electrical energy fields  B. Spinal column manipulation  C. Mind-body balance  D. Exercise of joints Correct Answer: B. Spinal column manipulation The theory underlying chiropractic is that interference with transmission of mental impulses between the brain and body organs produces diseases. Such interference is caused by misalignment of the vertebrae. Manipulation reduces the subluxation. NCLEXRN-01-018 Question Tag: wound care Question Category: Physiological Integrity, Physical Adaptation The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs two (2) hours ago. The nurse should  A. Place a call to the client’s health care provider for instructions  B. Send him to the emergency room for evaluation  C. Reassure the client’s wife that the symptoms are transient  D. Instruct the client’s wife to call the doctor if his symptoms become worse Correct Answer: B. Send him to the emergency room for evaluation This client requires immediate evaluation. A delay in treatment could result in further deterioration and harm. Home care nurses must prioritize interventions based on assessment findings that are in the client’s best interest.  Option A: Waiting to call for instructions may delay diagnosis of the patient.  Option C: Reassuring the wife is incorrect since it is not a transient symptom.  Option D: The symptoms are indicative of an emergency situation so the patient must be brought to the emergency department immediately. NCLEXRN-01-019 Question Tag: KUB radiograph Question Category: Physiological Integrity, Reduction of Risk potential Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter, Bladder) radiography test?  A. Client must be NPO before the examination  B. Enema to be administered prior to the examination  C. Medicate client with furosemide 20 mg IV 30 minutes prior to the examination  D. No special orders are necessary for this examination Correct Answer: D. No special orders are necessary for this examination There are no special orders for this procedure, however, the client must be instructed of the general rule during radiography tests: remove any clothing, jewelry, or objects that may interfere with the test.  Option A: There is no need to keep the client on NPO before the procedure.  Option B: Enemas are not recommended for any type of radiograph test.  Option C: Furosemide (Lasix) is unnecessary for this examination. NCLEXRN-01-020 Question Tag: myocardial infarction Question Category: Health Promotion and Maintenance The nurse is giving discharge teaching to a client seven (7) days post myocardial infarction. He asks the nurse why he must wait six (6) weeks before having sexual intercourse. What is the best response by the nurse to this question?  A. “You need to regain your strength before attempting such exertion.”  B. “When you can climb 2 flights of stairs without problems, it is generally safe.”  C. “Have a glass of wine to relax you, then you can try to have sex.”  D. “If you can maintain an active walking program, you will have less risk.” Correct Answer: B. “When you can climb 2 flights of stairs without problems, it is generally safe.” There is a risk of cardiac rupture at the point of the myocardial infarction for about six (6) weeks. Scar tissue should form about that time. Waiting until the client can tolerate climbing stairs is the usual advice given by healthcare providers.  Option A: The instruction in option A is vague and does not specifically tell the patient how to determine if the activity is already appropriate for him.  Option C: Having a glass of wine is not recommended for a client who just had a myocardial infarction.  Option D: Having an active walking program does not guarantee that the client has regained strength for a strenuous activity. NCLEXRN-01-021 Question Tag: triaging Question Category: Safe and Effective Care Environment, Management of Care A triage nurse has these four (4) clients arrive in the emergency department within 15 minutes. Which client should the triage nurse send back to be seen first?  A. A 2-month-old infant with a history of rolling off the bed and has bulging fontanelle with crying  B. A teenager who got a singed beard while camping  C. An elderly client with complaints of frequent liquid brown colored stools  D. A middle-aged client with intermittent pain behind the right scapula Correct Answer: B. A teenager who got a singed beard while camping This client is in the greatest danger with a potential of respiratory distress. Any client with singed facial hair has been exposed to heat or fire in close range that could have caused serious damage to the interior of the lungs. Note that the interior lining of the lungs have no nerve fibers so the client will not be aware of swelling.  Option A: When an infant is crying, the fontanels may look like they are bulging.  Option C: The client in Option C can wait to be seen within the first hour.  Option D: The client in Option D does not have a life-threatening condition but will still require immediate pain relief. A tall peaked T wave is a sign of hyperkalemia. The healthcare provider should be notified regarding discontinuing the medication.  Option A: Narrow QRS complex indicates fast cardiac rhythms (generally more than 100 beats/min) with a QRS duration of 100 ms or less.  Option B: A short PR interval (<120 ms) is seen with preexcitation syndromes and AV nodal (junctional) rhythm.  Option D: Prominent U waves are characteristic of hypokalemia. NCLEXRN-01-025 Question Tag: rhabdomyosarcoma Question Category: Physiological Integrity, Physiological Adaptation A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body?  A. All striated muscles  B. The cerebellum  C. The kidneys  D. The leg bones Correct Answer: A. All striated muscles Rhabdomyosarcoma is the most common children’s soft tissue sarcoma. It originates in striated (skeletal) muscles and can be found anywhere in the body. Symptoms of rhabdomyosarcoma include if the cancer is in the head or neck area: sudden bulging or swelling of the eyes, conjunctival chemosis, and headache. It can also affect the urinary or reproductive system. Its common site of metastasis is the lung.  Option B: The cerebellum is not affected in rhabdomyosarcoma.  Option C: The kidneys are not directly affected by the disease.  Option D: Bones are not directly affected by the disease. NCLEXRN-01-026 Question Tag: Chinese medicine Question Category: Health Promotion and Maintenance The nurse anticipates that for a family who practices Chinese medicine the priority goal would be to:  A. Achieve harmony  B. Maintain a balance of energy  C. Respect life  D. Restore yin and yang Correct Answer: D. Restore yin and yang For followers of Chinese medicine, health is maintained through the balance between the forces of yin and yang. Traditional Chinese medicine is a medical system that began being developed in China about 5000 years ago, which makes it the oldest continuous medical system on the planet.  Option A: Living in harmony with one’s natural environment with the aim of keeping all aspects of a person-mind, body, and spirit- in a state of harmony and balance so that disease never has a chance to develop.  Option B: This balance and healthy lifestyle are the focus of Chinese medicine which empowers the individual to participate in his own health.  Option C: In Chinese medicine, the body, and indeed a human being, is not seen as a machine, living in isolation from the world around it. Human beings are seen as part of the whole of things, which includes our environments, nature, and the universe itself. NCLEXRN-01-027 Question Tag: cardiomyopathy Question Category: Physiological Integrity, Physiological Adaptation During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of periodic dizzy spells. The nurse instructs the client to:  A. Increase fluids that are high in protein  B. Restrict fluids  C. Force fluids and reassess blood pressure  D. Limit fluids to non-caffeine beverages Correct Answer: C. Force fluids and reassess blood pressure Orthostatic hypotension, a decrease in systolic blood pressure of more than 15 mmHg and an increase in heart rate of more than 15 percent usually accompanied by dizziness indicate volume depletion, inadequate vasoconstrictor mechanisms, and autonomic insufficiency.  Option A: Fluids may not be necessarily protein rich.  Option B: Restricting fluids could aggravate the client’s dizziness.  Option D: There is no need to restrict the fluid intake of the client. NCLEXRN-01-028 Question Tag: pulmonary artery catheter, Swan-Ganz catheter Question Category: Physiological Integrity, Reduction of Risk Potential The nurse prepares the client for insertion of a pulmonary artery catheter (Swan- Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about:  A. Stroke volume  B. Cardiac output  C. Venous pressure  D. Left ventricular functioning Correct Answer: D. Left ventricular functioning The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated.  C. Inspiratory grunt  D. Increased heart rate with crying  E. Nasal flaring  F. Cyanosis  G. Asymmetric chest movement Correct Answers: C, E, F, & G  Option C. Grunting occurs when an infant attempts to maintain an adequate functional residual capacity in the face of poorly compliant lungs by partial glottic closure. As the infant prolongs the expiratory phase against this partially closed glottis, there is a prolonged and increased residual volume that maintains the airway opening and also an audible expiratory sound.  Option E: Nasal flaring occurs when the nostrils widen while breathing and is a sign of troubled breathing or respiratory distress.  Option F: Cyanosis refers to the bluish discoloration to the skin and indicates a decrease in oxygen attached to the red blood cells in the bloodstream.  Option G: Asymmetric chest movement occurs when the abnormal side of the lungs expands less and lags behind the normal side. This indicates respiratory distress.  Option A: Abdominal respiration is normal among infants and young children. Since their intercostal muscles are not yet fully developed, they use their abdominal muscles much more to pull the diaphragm down for breathing.  Option B: Newborns can have irregular breathing patterns ranging from 30 to 60 breaths per minute with short periods of apnea (15 seconds).  Option D: An increase in heart rate is normal for an infant during activity (including crying). Fluctuations in heart rate follow the changes in the newborn’s behavioral state – crying, movement, or wakefulness corresponds to an increase in heart rate. NCLEXRN-01-032 Question Tag: postmature fetus, maternal nursing Question Category: Health Promotion and Maintenance The nurse practicing in a maternity setting recognizes that the postmature fetus is at risk due to:  A. Excessive fetal weight  B. Low blood sugar levels  C. Depletion of subcutaneous fat  D. Progressive placental insufficiency Correct Answer: D. Progressive placental insufficiency Postmature or postterm pregnancy is a prolonged pregnancy that exceeds the limits of 38 to 42 weeks (normal term pregnancy). Infants of such pregnancy are considered postmature or dysmature if there is evidence that placental insufficiency has occurred and interfered with fetal growth. It occurs in 12% of all pregnancies. The placenta loses its adequacy to function after 42 weeks, after which it acquires calcium deposits which decreases the blood perfusion, supply of oxygen and nutrients to the fetus.  Option A,B, & C: Excessive fetal weight, hypoglycemia, and depletion of subcutaneous fat are all observed in a postmature fetus. NCLEXRN-01-033 Question Tag: total hip replacement Question Category: Physiological Integrity, Reduction of Risk Potential The nurse is caring for a client who had a total hip replacement seven (7) days ago. Which statement by the client requires the nurse’s immediate attention?  A. I have bad muscle spasms in my lower leg of the affected extremity.  B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.”  C. “I have to use the bedpan to pass my water at least every 1 to 2 hours.”  D. “It seems that the pain medication is not working as well today.” Correct Answer: B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” The nurse would be concerned about all of these comments, however, the most life-threatening is option B. Clients who had hip or knee surgery are at higher risk for development of postoperative pulmonary embolism. Sudden dyspnea and tachycardia are classic findings of pulmonary embolism. Without prophylaxis (e.g., anticoagulation medications), deep vein thrombosis can develop within 7 to 14 days following the surgery and can lead to pulmonary embolism. The nurse should be aware of the other signs of DVT which include: pain and tenderness at or below the area of the clot, skin discoloration, swelling or tightness of the affected leg. Signs of pulmonary embolism include: acute onset of dyspnea, tachycardia, confusion, and pleuritic chest pain.  Option A: Muscle spasms occur after total hip replacements and acute pain is expected after a surgical procedure.  Option C: May indicate urinary infection and needs further assessment by the nurse.  Option D: May require a reevaluation of pain and interventions to manage pain though does not need immediate action. NCLEXRN-01-034 Question Tag: furosemide, side effect Question Category: Physiological Integrity, Pharmacological and Parenteral Therapies A 33-year-old male client with heart failure has been taking furosemide for the past week. Which of the following assessment cues below may indicate the client is experiencing a negative side effect from the medication?  A. Weight gain of 5 pounds  B. Edema of the ankles  C. Gastric irritability Debridement may be sharp (e.g., using a curette or scissors), enzymatic, mechanical, biologic (i.e., using larvae), or autolytic. NCLEXRN-01-037 Question Tag: meperidine hydrochloride, atropine sulfate, promethazine hydrochloride Question Category: Physiological Integrity, Pharmacological and Parenteral Therapy A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethazine hydrochloride (Phenergan) 50 mg IM to a preoperative client. List the order in which the nurse must carry out the following actions prior to the administration of preoperative medications.  1. Have the client empty bladder  2. Instruct the client to remain in bed  3. Raise the side rails on the bed  4. Place the call bell within reach Correct order is shown above.  1. Have the client empty the bladder. The first step in the process is to have the client void prior to administering the pre-operative medication. If the client does not have a catheter, it is important to empty the bladder before receiving preoperative medications to prevent bladder injury (especially in pelvic surgeries). Else, a straight catheter or an indwelling catheter may be ordered to ensure the bladder is empty.  2. Instruct the client to remain in bed. Preoperative medications can cause drowsiness and lightheadedness which may put the client at risk for injury.  3. Raise the side rails on the bed. Raising the side rails on the bed helps prevent accidental falls and injury when the client decides to get out of the bed without assistance.  4. Place the call bell within reach. Call bells should always be within the reach of a client. NCLEXRN-01-038 Question Tag: nursing management and leadership, reward-feedback system Question Category: Health Promotion and Maintenance Which of these statements best describes the characteristics of an effective reward-feedback system?  A. Specific feedback is given as close to the event as possible  B. Staff is given feedback in equal amounts over time  C. Positive statements are to precede a negative statement  D. Performance goals should be higher than what is attainable Correct Answer: A. Specific feedback is given as close to the event as possible Feedback is most useful when given immediately. Positive behavior is strengthened through immediate feedback, and it is easier to modify problem behaviors if the standards are clearly understood.  Option B: Positive feedback is most useful when given immediately.  Option C: Negative statements are never helpful in any given situation.  Option D: Every goal should always be attainable. NCLEXRN-01-039 Question Tag: multiple sclerosis Question Category: Health Promotion and Maintenance The nurse is providing information to a client with multiple sclerosis on performing exercises and physical activities. The nurse determines the client needs additional teaching if the client makes which statements? Select all that apply.  A. “I can lift weights and do resistance training.”  B. “I should exercise to the point of exhaustion.”  C. “I can include aerobic exercises in my routine.”  D. “Proper stretching should be done before starting my routine.”  E. “I should exercise continuously without rest.” Correct answers: B & E.  Option B: Patients with multiple sclerosis should not exercise to the point of fatigue as strenuous physical exercise raises body temperature and may aggravate symptoms.  Option E: Continuous exercise with no rest periods is contraindicated for patients with multiple sclerosis who want to exercise. The patient should be advised to take short rest periods, preferably lying down. Again, extreme fatigue may contribute to the exacerbation of symptoms.  Option A: Exercises should include activities that would strengthen weak muscles because diminishing muscle strength is often a primary concern in multiple sclerosis. These activities include lifting weights and resistance exercises.  Option C: Aerobic exercises help promote muscle efficiency, increase flexibility, improves mood, and helps eliminate stress.  Option D: Muscle stretching should be included prior to exercise as this helps minimize muscle spasticity and contractures which is common in later stages of multiple sclerosis. NCLEXRN-01-040 Question Tag: home care, Alzheimer’s disease Question Category: Safe and Effective Care Environment, Safety and Infection Control During the evaluation of the quality of home care for a client with Alzheimer’s disease, the priority for the nurse is to reinforce which statement by a family member?  A. “At least two (2) full meals a day are eaten.”  B. “We go to a group discussion every week at our community center.”  C. “We have safety bars installed in the bathroom and have 24-hour alarms on the doors.”  D. “The medication is not a problem to have it taken three (3) times a day.”  D. Sulfamethoxazole and Trimethoprim (Bactrim)  E. Isotretinoin (Accutane)  F. Nitro-Dur patch Correct Answer: A, B, C, D, and E. Photosensitivity is an extreme sensitivity to ultraviolet (UV) rays from the sun and other light sources. A type of photosensitivity called Phototoxic reactions are caused when medications in the body interact with UV rays from the sun. Anti- infectives are the most common cause of this type of reaction.  Option A: Ciprofloxacin is used to treat a variety of bacterial infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for virus infections (such as common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.  Option B: Sulfonamides are synthetic bacteriostatic antibiotics that competitively inhibit conversion of p-aminobenzoic acid to dihydropteroate, which bacteria need for folate synthesis and ultimately purine and DNA synthesis. Humans do not synthesize folate but acquire it in their diet, so their DNA synthesis is less affected.  Option C: Norfloxacin is an antibiotic in a group of drugs called fluoroquinolones. Norfloxacin fights bacteria in the body. Norfloxacin is used to treat different bacterial infections of the prostate or urinary tract (bladder and kidneys). Norfloxacin is also used to treat gonorrhea.  Option D: Sulfamethoxazole and trimethoprim combination is used to treat infections such as urinary tract infections, middle ear infections (otitis media), bronchitis, traveler’s diarrhea, and shigellosis (bacillary dysentery). This medicine is also used to prevent or treat Pneumocystis jiroveci pneumonia or Pneumocystis carinii pneumonia (PCP), a very serious kind of pneumonia. Sulfamethoxazole and trimethoprim combination is an antibiotic. It works by eliminating the bacteria that cause many kinds of infections.  Option E: Isotretinoin is a drug used to treat severe acne that hasn’t responded to other treatments. It may be prescribed for other uses, including other skin problems and certain kinds of cancer. This drug is a vitamin A derivative (retinoid), so your body reacts to it in a similar way that it does to vitamin A.  Option F: Nitro-Dur patch is used to prevent chest pain or angina. Its side effects are headache, lightheadedness, nausea, and flushing. NCLEXRN-01-043 Question Tag: discolored urine Question Category: Physiological Integrity, Pharmacological and Parenteral Therapy A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration?  A. Sulfasalazine  B. Levodopa  C. Phenolphthalein  D. Aspirin Correct Answer: D. Aspirin Aspirin is not known to cause discoloration of the urine. Side effects and complications of taking aspirin include stroke caused by a burst blood vessel. The Food and Drug Administration doesn’t recommend aspirin therapy for the prevention of heart attacks in people who haven’t already had a heart attack, stroke or another cardiovascular condition.  Option A: Sulfasalazine may discolor the urine or skin to orange-yellow color. Sulfasalazine is used to treat ulcerative colitis (UC), and to decrease the frequency of UC attacks. Sulfasalazine will not cure ulcerative colitis, but it can reduce the number of attacks you have.  Option B: Levodopa may discolor the urine, saliva, or sweat to a dark brown color. Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing levodopa from being broken down before it reaches the brain.  Option C: Phenolphthalein can discolor the urine to a red color. Phenolphthalein is often used as an indicator in acid–base titrations. For this application, it turns colorless in acidic solutions and pink in basic solutions. NCLEXRN-01-044 Question Tag: refrigerated drugs Question Category: Physiological Integrity, Pharmacological and Parenteral Therapy You are responsible for reviewing the nursing unit’s refrigerator. Which of the following drugs, if found inside the fridge, should be removed?  A. Nadolol (Corgard)  B. Opened (in-use) Humulin N injection  C. Urokinase (Kinlytic)  D. Epoetin alfa IV (Epogen) Correct Answer: A. Corgard Nadolol (Corgard) is stored at room temperature between 59 to 86 ºF (15 and 30 ºC) away from heat, moisture, and light. Do not store it in the bathroom and keep the bottle tightly closed.  Option B: Humulin N injection if unopened (not in use) is stored in the fridge and can be used until the expiration date, or stored at room temperature and used within 31 days. If opened (in-use), store the vial in a refrigerator or at room temperature and use within 31 days. Store the injection pen at room temperature (do not refrigerate) and use it within 14 days. Keep it in its original container protected from heat and light. Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do not freeze insulin or store it near the cooling element in a refrigerator. Throw away any insulin that has been frozen.  Option A: Before reporting to a social worker, it is imperative to start a prophylaxis to reduce viral replication.  Option C: Pentamidine is an antimicrobial medication given to prevent and treat pneumocystis pneumonia.  Option D: It is natural to have strong emotions after an exposure to HIV in the workplace. The healthcare worker might feel anger, fear, blame, or depression. During the difficult time of prevention treatment and waiting, they may want to seek support. Try an employee-assistance program or local mental health expert. NCLEXRN-01-047 Question Tag: insulin-dependent, diabetes Question Category: Physiological Integrity, Physiological Adaptation A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect?  A. Atherosclerosis  B. Diabetic nephropathy  C. Autonomic neuropathy  D. Somatic neuropathy Correct Answer: C. Autonomic neuropathy Autonomic neuropathy (also known as Diabetic Autonomic Neuropathy) affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs. Paralysis of the bladder is a common symptom of this type of neuropathy, as manifested by bladder urgency and inability to start urination.  Option A: Atherosclerosis, or hardening of the arteries, is a condition in which plaque builds up inside the arteries. Plaque is made of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood).  Option B: Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and an increased need to urinate.  Option D: Somatic neuropathy affects the whole body and presents diverse clinical pictures, most common is the development of diabetic foot followed by diabetic ulceration and possible amputation. NCLEXRN-01-048 Question Tag: BMI, induced vomiting, constipation Question Category: Physiological Integrity, Physiological Adaptation You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect?  A. Multiple sclerosis  B. Anorexia nervosa  C. Bulimia nervosa  D. Systemic sclerosis Correct Answer: B. Anorexia nervosa All of the clinical signs and symptoms point to a condition of anorexia nervosa. The key feature of anorexia nervosa is self-imposed starvation, resulting from a distorted body image and an intense, irrational fear of gaining weight, even when the patient is emaciated. Anorexia nervosa may include refusal to eat accompanied by compulsive exercising, self-induced vomiting, or laxative or diuretic abuse.  Option A: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of the nerve cells in the brain and spinal cord are damaged.  Option C: On the other hand, bulimia nervosa features binge eating followed by a feeling of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting, use of laxatives or diuretics.  Option D: Systemic sclerosis or systemic scleroderma is an autoimmune disease of the connective tissue. NCLEXRN-01-049 Question Tag: myeloma, confusion Question Category: Physiological Integrity, Physiological Adaptation A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect?  A. Diverticulosis  B. Hypercalcemia  C. Hypocalcemia  D. Irritable bowel syndrome Correct Answer: B. Hypercalcemia Hypercalcemia can cause polyuria, severe abdominal pain, and confusion.  Option A: Diverticulosis is a condition that develops when pouches (diverticula) form in the wall of the large intestine; most people don’t have symptoms.  Option C: Hypocalcemia is low calcium levels in the blood; it is asymptomatic in mild forms but can cause paresthesia, tetany, muscle cramps, and carpopedal spasms in severe hypocalcemia.  Option D: Irritable bowel syndrome is a widespread condition involving recurrent abdominal pain and diarrhea or constipation, often associated with stress, depression, anxiety, or previous intestinal infection. behavioral problems, and psychiatric disorders are also common. Untreated individuals may have a musty or mouse-like odor as a side effect of excess phenylalanine in the body. Children with classic PKU tend to have lighter skin and hair than unaffected family members and are also likely to have skin disorders such as eczema. NCLEXRN-01-052 Question Tag: overdose, aspirin Question Category: Physiological Integrity, Pharmacological and Parenteral Therapy A patient has taken an overdose of aspirin. Which of the following should a nurse must closely monitor during acute management of this patient?  A. Onset of pulmonary edema  B. Metabolic alkalosis  C. Respiratory alkalosis  D. Parkinson’s disease type symptoms Correct Answer: A. Onset of pulmonary edema Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development. Early symptoms of aspirin poisoning also include tinnitus, hyperventilation, vomiting, dehydration, and fever. Late signs include drowsiness, bizarre behavior, unsteady walking, and coma. Abnormal breathing caused by aspirin poisoning is usually rapid and deep. Pulmonary edema may be related to an increase in permeability within the capillaries of the lung leading to “protein leakage” and transudation of fluid in both renal and pulmonary tissues. The alteration in renal tubule permeability may lead to a change in colloid osmotic pressure and thus facilitate pulmonary edema (via Medscape).  Option B: Aspirin overdose causes metabolic acidosis, not alkalosis. Metabolic alkalosis is a primary increase in serum bicarbonate (HCO3 -) concentration.  Option C: Respiratory alkalosis is a disturbance in acid and base balance due to alveolar hyperventilation.  Option D: Parkinson’s type symptoms include tremors, bradykinesia, rigid muscles, impaired posture and balance, speech changes, and loss of automatic movements. NCLEXRN-01-053 Question Tag: blind, deaf Question Category: Safe and Effective Care Environment, Safety and Infection Control A 50-year-old blind and deaf patient has been admitted to your floor. As the charge nurse, your primary responsibility for this patient is?  A. Let others know about the patient’s deficits.  B. Communicate with your supervisor your patient safety concerns.  C. Continuously update the patient on the social environment.  D. Provide a secure environment for the patient. Correct Answer: D. Provide a secure environment for the patient. This patient’s safety is your primary concern. Patient safety protocols can help reduce medical mistakes and prevent adverse patient outcomes. When the goal is to help people, it seems obvious that it’s important to work to protect them from unintended or unexpected harm.  Option A: Letting others know is correct, so that the other staff may become aware of the patient’s condition. However, this is not a priority.  Option B: Before communication with the supervisor, the charge nurse must secure the environmental safety of the client first.  Option C: Option C is also correct, but this can come after securing the client’s safety. NCLEXRN-01-054 Question Tag: COPD, PVD Question Category: Physiological Integrity, Pharmacological and Parenteral Therapy A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the following would be the best instruction for this patient?  A. Deep breathing techniques to increase oxygen levels.  B. Cough regularly and deeply to clear airway passages.  C. Cough following bronchodilator utilization.  D. Decrease CO2 levels by increased oxygen take output during meals. Correct Answer: C. Cough following bronchodilator utilization The bronchodilator will allow a more productive cough.  Option A: Deep breathing exercises can help the client’s lungs from becoming more damaged. When one has healthy lungs, breathing is natural and easy. You breathe in and out with the diaphragm doing about 80 percent of the work to fill the lungs with a mixture of oxygen and other gases, and then to send the waste gas out.  Option B: Coughing may help clear the airway, however, it may not be as effective as taking bronchodilators. Coughing moves mucus out of the large airways. However, moving mucus out of the small airways requires airway clearance techniques (ACTs). This is why coughing should be done with other ACTs.  Option D: Changing the level of oxygen at home without asking the healthcare provider is not recommended. Correct Answer: D. Observe for signs of bleeding. Bleeding is the priority concern for a client taking thrombolytic medication. The primary mechanism of all thrombolytics is the conversion of plasminogen to the active form, plasmin, which then degrades fibrin. This proteolysis can occur with fibrin-bound plasminogen on the surface of thrombi and the unbound form within the plasma. The unbound plasmin generated degrades fibrin but also fibrinogen, factor V, and factor VIII.  Option A: During therapy, perform neurologic assessment every 15 minutes during the 1-hour infusion. After therapy, check every 15 minutes for the first hours after cessation of infusion, then every 30 minutes for the next 6 hours.  Option B: Although current guidelines do not include renal dysfunction as a contraindication to tPA therapy, some clinicians hesitate to administer tPA because of a tendency of bleeding in these patients.  Option C: Having a food diary is not related to the use of medication. Thrombolytic therapy is indicated in patients with evidence of ST-segment elevation MI (STEMI) or presumably new left bundle-branch block (LBBB) presenting within 12 hours of the onset of symptoms if there are no contraindications to fibrinolysis. NCLEXRN-01-058 Question Tag: folic acid Question Category: Physiologic Integrity, Basic Care and Comfort A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?”  A. Green vegetables and liver  B. Yellow vegetables and red meat  C. Carrots  D. Milk Correct Answer: A. Green vegetables and liver Green vegetables and liver are a great source of folic acid.  Option B: Yellow vegetables are great sources of vitamins, such as vitamins A, B6, C, folate, magnesium, fiber, riboflavin, phosphorus, and potassium. Red meat is rich in protein, saturated fat, iron, zinc, and vitamin B.  Option C: Carrots are a rich source of vitamin A from beta carotene, K1 (phylloquinone), and vitamin B6.  Option D: Milk is a rich source of calcium. Milk is an excellent source of many vitamins and minerals, including vitamin B12, calcium, riboflavin, and phosphorus. It’s often fortified with other vitamins, especially vitamin D. NCLEXRN-01-059 Question Tag: meningitis Question Category: Physiological Integrity, Physiological Adaptation A nurse is putting together a presentation on meningitis. Which of the following microorganisms has not been linked to meningitis in humans?  A. S. pneumoniae  B. H. influenzae  C. N. meningitidis  D. Cl. difficile Correct Answer: D. Cl. difficile Cl. difficile has not been linked to meningitis. Clostridium difficile (C. diff ) is a germ (bacteria) that causes life-threatening diarrhea. It is usually a side-effect of taking antibiotics.  Option A: Pneumococcal meningitis is caused by Streptococcus pneumoniae. The most common route of infection starts by nasopharyngeal colonization by Streptococcus pneumoniae, which must avoid mucosal entrapment and evade the host immune system after local activation.  Option B: H influenzae meningitis is caused by Haemophilus influenzae type B bacteria. It is the leading cause of bacterial meningitis in children under age 5. Haemophilus species are small oxidase-positive pleomorphic gram-negative aerobic or facultative anaerobic coccobacilli. Humans are the only known host for Haemophilus influenzae.  Option C: Bacteria called Neisseria meningitidis cause meningococcal disease. About 1 in 10 people have these bacteria in the back of their nose and throat without being ill. NCLEXRN-01-060 Question Tag: hemoglobin, RBC Question Category: Physiologic Integrity, Physiological Adaptation A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long do red blood cells live in my body? The correct response is:  A. The life span of RBC is 45 days  B. The life span of RBC is 60 days  C. The life span of RBC is 90 days  D. The life span of RBC is 120 days Correct Answer: D. The life span of RBC is 120 days. Red blood cells have a lifespan of 120 in the body. Today, RBC population studies are performed with a label that is placed on the RBC ex vivo, making it possible to study both donor and autologous RBC.  Option A: Human red blood cells (RBC), after differentiating from erythroblasts in the bone marrow, are released into the blood and survive in the circulation for approximately 115 days. In humans and some other species, RBC normally survives in a nonrandom manner. This means that all of the RBC in an age cohort are removed by the reticuloendothelial system at about the same time.  Option B: Accurate measurement of long-term survival requires determination of the amount of remaining labeled RBC for all or most of the RBC lifespan. Optimal determination of long-term survival also requires a steady state situation, with the important variable depending on the label used. A toddler is 26 months old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the toddler in?  A. Trust vs. mistrust  B. Initiative vs. guilt  C. Autonomy vs. shame and doubt  D. Intimacy vs. isolation Correct Answer: C. Autonomy vs. shame and doubt Autonomy vs Shame and doubt is the second stage of Erik Erikson’s stages of psychosocial development. This stage occurs between the ages of 18 months to 3 years. According to Erikson, children at this stage are focused on developing a greater sense of control.  Option A: Trust vs Mistrust is the first stage of psychosocial theory. This stage begins at birth and continues to approximately 18 months of age. During this stage, children learn whether or not they can trust the people around them.  Option B: It is as children enter the preschool years (3-6 years old) that they begin the third stage of psychosocial development centered on initiative versus guilt. It is important for the kids to learn that they can exert power over themselves and the world.  Option D: Intimacy vs Isolation takes place during young adulthood between the ages of approximately 19 and 40. The major conflict at this stage of life centers on forming intimate, loving relationships with other people. NCLEXRN-01-064 Question Tag: psychosocial development, Erik Erikson, young adult Question Category: Psychosocial Integrity A young adult is 20 years old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the adult in?  A. Trust vs. mistrust  B. Initiative vs. guilt  C. Autonomy vs. shame  D. Intimacy vs. isolation Correct Answer: D. Intimacy vs. isolation Intimacy vs Isolation takes place during young adulthood between the ages of approximately 19 and 40. The major conflict at this stage of life centers on forming intimate, loving relationships with other people.  Option A: Trust vs Mistrust is the first stage of psychosocial theory. This stage begins at birth and continues to approximately 18 months of age. During this stage, children learn whether or not they can trust the people around them.  Option B: It is as children enter the preschool years (3-6 years old) that they begin the third stage of psychosocial development centered on initiative versus guilt. It is important for the kids to learn that they can exert power over themselves and the world.  Option C: Autonomy vs Shame and doubt is the second stage of Erik Erikson’s stages of psychosocial development. This stage occurs between the ages of 18 months to 3 years. According to Erikson, children at this stage are focused on developing a greater sense of control. NCLEXRN-01-065 Question Tag: vital signs Question Category: Physiological Integrity, Reduction of Risk Potential A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal?  A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg  B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg  C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg  D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg Correct Answer: B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg Normal range of vital signs for 11 to 14 year olds: Heart rate: 60-105 BPM; Respiratory rate: 12-20 CPM; Blood pressure: Systolic-85-120, diastolic- 55-80 mmHg; Body temperature: 98.0 degrees Fahrenheit (36.6 degrees Celsius) to 98.6 degrees Fahrenheit (37 degrees Celsius). The client’s diastolic pressure is lower than the normal range. Both her respiratory rate and heart rate are slightly increased.  Option A: Client’s heart rate and BP are within normal range, respiratory rate slightly increased.  Option C: Normal range of vital signs for 3-5 year olds: Heart rate: 80-120 BPM; Respiratory rate: 20-30 CPM; Blood pressure: 80-110 (systolic), 50-80 (diastolic). All vital signs are within normal range.  Option D: Normal range of vital signs for 6-10 year olds: Heart rate: 70- 110 BPM; Respiratory rate: 15-30 CPM; Blood pressure: 85-120 (systolic), 55-80 (diastolic). All vital signs are within normal range. NCLEXRN-01-066 Question Tag: depression, anxiety disorder, history Question Category: Physiological Integrity, Pharmacological and Parenteral Therapy When you are taking a patient’s history, she tells you she has been depressed and is dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking?  A. Amitriptyline (Elavil)  B. Calcitonin  C. Pergolide mesylate (Permax)  D. Verapamil (Calan) Correct Answer: A. Amitriptyline (Elavil) Amitriptyline (Elavil) is a tricyclic antidepressant and used to treat symptoms of depression. NCLEXRN-01-069 Question Tag: ketoacidosis Question Category: Physiological Integrity, Physiological Adaptation A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute?  A. Vomiting  B. Extreme Thirst  C. Weight gain  D. Acetone breath smell Correct Answer: C. Weight gain Rapid weight loss occurs in patients newly diagnosed with type 1 diabetes. In people with diabetes, insufficient insulin prevents the body from getting glucose from the blood into the body’s cells to use as energy. When this occurs, the body starts burning fat and muscle for energy, causing a reduction in overall body weight.  Option A: Nausea and vomiting usually occur and may be associated with diffuse abdominal pain, decreased appetite, and anorexia. As the blood glucose levels rise and fall, the body’s metabolism can get interrupted and confused which can lead to a mixed feeling of nausea.  Option B: The incidence of increased water loss results in extreme thirst and dehydration. If our blood glucose levels are higher than they should be for prolonged periods of time, our kidneys will attempt to remove some of the excess glucose from the blood and excrete this as urine. Whilst the kidneys filter the blood in this way, water will also be removed from the blood and will need replenishing. This is why we tend to have increased thirst when our blood glucose levels run too high.  Option D: A characteristic sign of ketoacidosis is acetone (ketotic) breath, or a fruity smell. When the body can’t get energy from glucose, it burns fat in its place. The fat-burning process creates a buildup of acids in the blood called ketones, which leads to DKA if untreated. Fruity-smelling breath is a sign of high levels of ketones in someone who already has diabetes. NCLEXRN-01-070 Question Tag: meningitis Question Category: Physiological Integrity, Physiological Adaptation A patient’s chart indicates a history of meningitis. Which of the following would you NOT expect to see with this patient if this condition were acute?  A. Increased appetite  B. Vomiting  C. Fever  D. Poor tolerance of light Correct Answer: A. Increased appetite Loss of appetite would be expected. Most cases of meningitis are caused by an infectious agent that has colonized or established a localized infection elsewhere in the host. Potential sites of colonization or infection include the skin, the nasopharynx, the respiratory tract, the gastrointestinal (GI) tract, and the genitourinary tract. The organism invades the submucosa at these sites by circumventing host defenses (eg, physical barriers, local immunity, and phagocytes or macrophages).  Option B: Vomiting occurs in 35% of patients with meningitis.The brain is naturally protected from the body’s immune system by the barrier that the meninges create between the bloodstream and the brain. Normally, this protection is an advantage because the barrier prevents the immune system from attacking the brain. However, in meningitis, the blood-brain barrier can become disrupted; once bacteria or other organisms have found their way to the brain, they are somewhat isolated from the immune system and can spread.  Option C: The classic triad of meningitis consists of fever, nuchal rigidity, and altered mental status. When the body tries to fight the infection, the problem can worsen; blood vessels become leaky and allow fluid, WBCs, and other infection-fighting particles to enter the meninges and brain. This process, in turn, causes brain swelling and can eventually result in decreasing blood flow to parts of the brain, worsening the symptoms of infection.  Option D: Other symptoms include photalgia (photophobia): discomfort when the patient looks into bright lights. Depending on the severity of bacterial meningitis, the inflammatory process may remain confined to the subarachnoid space. In less severe forms, the pial barrier is not penetrated, and the underlying parenchyma remains intact. However, in more severe forms of bacterial meningitis, the pial barrier is breached, and the underlying parenchyma is invaded by the inflammatory process. Thus, bacterial meningitis may lead to widespread cortical destruction, particularly when left untreated. NCLEXRN-01-071 Question Tag: conjunctivitis Question Category: Physiological Integrity, Physiological Adaptation A nurse is reviewing a patient’s chart and notices that the patient suffers from conjunctivitis. Which of the following microorganisms is related to this condition?  A. Yersinia pestis  B. Helicobacter pylori  C. Vibrio cholerae  D. Haemophilus aegyptius Correct Answer: D. Haemophilus aegyptius Haemophilus influenzae biogroup aegyptius (Hae) is a causative agent of acute and often purulent conjunctivitis, more commonly known as pink eye.  Option A: Plague is a disease that affects humans and other mammals. It is caused by the bacterium, Yersinia pestis. Y. pestis is primarily a disease of rodents or other wild mammals that usually is transmitted by fleas and often is fatal. Human disease is now rare and usually is associated with contact with rodents and their fleas.  Option B: Helicobacter pylori (H. pylori) infection occurs when H. pylori bacteria infect the stomach. Helicobacter pylori is a ubiquitous organism that is present in about 50% of the global population. Chronic infection with H pylori causes atrophic and even metaplastic changes in the antithrombotic agents (eg, dabigatran, rivaroxaban), not including thyroid studies. NCLEXRN-01-074 Question Tag: mobility, weight gain Question Category: Physiological Integrity, Reduction of Risk Potential An 85-year-old male has been losing mobility and gaining weight over the last two (2) months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?  A. CBC (complete blood count)  B. ECG (electrocardiogram)  C. Thyroid function tests  D. CT scan Correct Answer: C. Thyroid function tests Weight gain and poor temperature tolerance indicate something may be wrong with the thyroid function. Thyroid function tests are designed to distinguish hyperthyroidism and hypothyroidism from the euthyroid state. To accomplish this task, direct measurements of the serum concentration of the two thyroid hormones—triiodothyronine (T3) and tetraiodothyronine (T4)—more commonly known as thyroxine, are extensively employed.  Option A: The complete blood count and metabolic profile may show abnormalities in patients with hypothyroidism. Thyroid dysfunction induces different effects on blood cells such as anemia, erythrocytosis, leukopenia, thrombocytopenia, and in rare cases causes’ pancytopenia.  Option B: Signs of hypothyroidism on ECG include sinus bradycardia, T- wave inversions (TWIs), QTc prolongation and ventricular arrhythmias. Hypothyroidism can affect the cardiovascular system physiology and structure. These changes are often reflected on ECG.  Option D: Ultrasonography of the neck and thyroid can be used to detect nodules and infiltrative disease. High-resolution ultrasonography (USG) is the most sensitive imaging modality available for examination of the thyroid gland and associated abnormalities. Ultrasound scanning is non- invasive, widely available, less expensive, and does not use any ionizing radiation. Further, real time ultrasound imaging helps to guide diagnostic and therapeutic interventional procedures in cases of thyroid disease. NCLEXRN-01-075 Question Tag: fever, rash Question Category: Physiological Integrity, Reduction of Risk Potential A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?  A. Blood sugar check  B. CT scan  C. Blood cultures  D. Arterial blood gases Correct Answer: C. Blood cultures Blood cultures would be performed to investigate the fever and rash symptoms. A blood culture is a test that checks for foreign invaders like bacteria, yeast, and other microorganisms in the blood. Having these pathogens in the bloodstream can be a sign of a blood infection, a condition known as bacteremia. A positive blood culture means that there are bacteria in the blood.  Option A: Blood sugar check is necessary for clients who are suspected of having an increase in blood sugar and whose symptoms include excessive thirst and hunger, and excessive sweating.  Option B: CT scan is unnecessary at the time for a client with fever and rash. A computerized tomography (CT) scan combines a series of X-ray images taken from different angles around the body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside the body. CT scan images provide more- detailed information than plain X-rays do.  Option D: An arterial blood gas (ABG) test measures oxygen and carbon dioxide levels in the blood. It also measures the body’s acid-base (pH) level, which is usually in balance when healthy.