Free NCLEX practice questions, with the reasoning

Question 1

A client asks the nurse why a total thyroidectomy carries a risk of a low calcium. Which response by the nurse is correct?

Accepted Answer

B: "The four glands that control calcium sit on the back of the thyroid and are easily injured.". The parathyroid glands are four small glands sitting on the back surface of the thyroid, and they are the glands that control calcium. Taking out the whole thyroid puts them in the surgical field, and they can be bruised, have their blood supply interrupted, or be removed with the specimen.

That is why the low calcium of a thyroidectomy arrives on a schedule. It shows up at about 24 to 48 hours rather than in the recovery room, and a nurse who knows the timing is checking for it before the client complains.

Question 2

A 74-year-old client was admitted for depression 2 weeks after the death of his wife. He is tearful and says, "I keep expecting her to walk through the door." Which of the following statements would be appropriate for the nurse to make?

Accepted Answer

D: "It is hard to lose your wife after so many years together.". Grief is the normal emotional response to loss. Two weeks after a death, expecting to see the person, crying and yearning are expected. The nurse's role is to acknowledge the loss and the feelings and to be present, not to fix them.

Stating the obvious in an empathic way ("It is hard to lose someone you have loved") is therapeutic. It names the loss, shows understanding and lets the client keep talking about his wife if he wants to.

Question 3

A 78-year-old client is 1 day after surgical repair of a hip fracture. The health care provider prescribes enoxaparin 30 mg subcutaneously every 12 hours, and the medication is supplied in a prefilled syringe. Which actions should the nurse take when giving the injection?

Accepted Answer

A: Hold the pinched skin fold for the length of the injection; D: Leave the air bubble in the prefilled syringe before injecting; E: Inject into the abdomen at least 2 inches from the umbilicus. Enoxaparin is a low-molecular-weight heparin. It blocks clotting factor Xa and is given after hip fracture surgery because the combination of a long bone injury, surgery, and immobility makes deep vein thrombosis very likely.

The technique is designed to prevent bruising and get the full dose in. The air bubble in the prefilled syringe is left in place, because it pushes the last of the drug out of the needle and seals it in the tissue. The injection goes into the fatty tissue of the abdomen, at least 2 inches from the umbilicus, alternating right and left sides. The nurse pinches a fold of skin, inserts the whole needle at 90 degrees, and holds the fold for the whole injection so the drug stays in the subcutaneous layer.

Question 4

The nurse is seeing a 63-year-old client at a follow-up visit 2 weeks after a myocardial infarction. Which of the following statements by the client would require follow-up?

Accepted Answer

B: "I wake up at 3 in the morning most nights and can't get back to sleep."; C: "I don't really enjoy it anymore when my grandchildren come to visit."; D: "What's the point of going to rehab? I'm never going to be the same.". Depression develops in about 1 in 5 clients after a myocardial infarction. It is more than sadness, and it matters to the heart as well as the mind, because depressed clients are less likely to take their medications, attend rehabilitation, or change their habits, and their risk of death after an infarction is higher.

The keyed statements are its warning signs. Early waking that the client cannot sleep through is a classic sleep change in depression. Losing pleasure in things that used to bring joy, such as grandchildren, is anhedonia. Feeling that recovery is pointless is hopelessness. The nurse screens for depression with a standard tool, asks directly about thoughts of self-harm, and arranges referral.

Question 5

A nurse is preparing to enter the room of a client on contact precautions. Place the steps in the correct order.

Accepted Answer

1: Perform hand hygiene; 2: Put on the gown; 3: Put on gloves. Contact precautions call for hand hygiene, then a gown, then gloves, and the order is the sequence rather than an arbitrary list.

Hand hygiene comes first because everything else goes on with those hands. The gown goes on next, and it covers the torso and arms, which are what will be against the client and the bed. Gloves go on last so they can be pulled over the gown cuffs, closing the gap at the wrist. Putting gloves on before the gown leaves that wrist gap open.

Notice what is not on the contact list. There is no mask and no eye protection, because the organism is not traveling through the air.

Question 6

The nurse is preparing medication teaching for clients with anxiety disorders who have new prescriptions for lorazepam, buspirone, or sertraline. For each statement below, click to specify if the statement is consistent with lorazepam, buspirone, or sertraline. Each statement may be consistent with more than one medication.

Accepted Answer

Can cause sexual dysfunction, such as decreased desire or delayed orgasm: Sertraline; Is not a controlled substance: Buspirone, Sertraline; Causes dangerous sedation and slowed breathing when taken with opioids or alcohol: Lorazepam; Can cause physical dependence and withdrawal seizures if stopped suddenly: Lorazepam; Must be taken every day for several weeks before the full effect is felt: Buspirone, Sertraline; Relieves anxiety within an hour of a dose: Lorazepam. Lorazepam is a benzodiazepine. It enhances GABA, the brain's main calming signal, so it works quickly, within an hour by mouth, and it is used short term or for acute anxiety. The cost is dependence: regular use leads to tolerance, and stopping suddenly can cause withdrawal with seizures. It is a controlled substance, and its sedating effect adds to that of opioids and alcohol, which together can stop breathing.

Buspirone works on serotonin receptors. It is not sedating, has no dependence risk, and is not controlled, but it takes 2 to 4 weeks of daily dosing to work.

Sertraline is an SSRI and a first-line long-term treatment for anxiety disorders. It is not controlled and takes several weeks to reach full effect. Sexual dysfunction is one of its common adverse effects and a frequent reason clients stop it, so the nurse asks about it.

Question 7

A 34-year-old client in the intensive care unit with cerebral edema after a traumatic brain injury is receiving mannitol 1 g/kg IV every 6 hours. Before the 1800 dose, the nurse reviews the flow sheet. Which finding requires follow-up?

Accepted Answer

B: Serum osmolality 326 mOsm/kg. Mannitol is an osmotic diuretic. It raises the serum osmolality, which draws water out of the swollen brain into the blood vessels, and the kidneys then excrete it. A moderate rise in osmolality is the point of the drug, but there is a ceiling. Above about 320 mOsm/kg, more mannitol adds little benefit and the risk of acute kidney injury, dehydration, and electrolyte problems rises.

The osmolality has climbed with each dose and is now 326 mOsm/kg, above that limit. The nurse holds the 1800 dose and contacts the provider, who may stop the mannitol or switch to another option such as hypertonic saline. Everything else on the flow sheet shows the drug is working without harm.

Question 8

A 56-year-old client with pulmonary tuberculosis has received rifampin, isoniazid, pyrazinamide, and ethambutol by directly observed therapy for 5 weeks. At the monthly clinic visit, the nurse reviews the client's assessment findings and record. Select the 3 findings that require follow-up.

Accepted Answer

B: Yellow sclerae noted on inspection at today's visit; D: Anorexia, nausea, and right upper quadrant abdominal pain; E: Numbness and burning of both feet for the past week. Tuberculosis (TB) is a contagious bacterial infection that most often affects the lungs.

The first-line drugs for tuberculosis work, but three of them can injure the liver. Isoniazid, rifampin, and pyrazinamide are all hepatotoxic, and the risk rises with age, alcohol use, and other liver disease. Loss of appetite, nausea, and pain in the right upper abdomen are the early signs, and yellow sclerae mean bilirubin is already building up. These are reported right away, the doses are held as prescribed, and liver function tests are checked.

Numbness and burning in the feet is peripheral neuropathy from isoniazid, which interferes with vitamin B6 (pyridoxine). It is reported so that pyridoxine can be added or increased, and it is usually prevented by giving pyridoxine with isoniazid from the start in clients at risk.

Question 9

A nurse is preparing to enter an isolation room. Place the personal protective equipment in the order it should be put on.

Accepted Answer

1: Put on the gown; 2: Put on the mask; 3: Put on goggles; 4: Put on gloves. Gown, mask, goggles, gloves. It works from the body outward and from clean hands to covered hands.

The gown goes on first because it is the largest item and needs both hands free to tie at the neck and waist. The mask goes on next and is secured and moulded to the nose, then goggles or a face shield sit over it. Gloves go on last, pulled over the gown cuffs, so there is no bare skin at the wrist and no need to touch the face or adjust anything afterward.

Question 10

A client in soft wrist restraints for pulling at a tracheostomy is being reassessed at 1200. Which of the following findings indicate that the nurse should consider removing the restraints? Select two.

Accepted Answer

A: The client follows commands and no longer reaches for the tracheostomy; B: A trained sitter is available to stay at the bedside with the client. Restraints are removed as soon as the behavior that required them has ended, or when a less restrictive measure can keep the client safe. A client who now follows commands and no longer reaches for the tracheostomy no longer meets the criteria for restraint. A trained sitter who stays at the bedside is a less restrictive alternative that can protect the airway, with the RN reassessing the client regularly.

Free NCLEX practice questions, with the reasoning.