NCLEX PN

1NCLEX-RN Review CourseTest-Taking Workshop12Test taking Workshop

2NCLEX-RN Measures Nursing KnowledgeTesttaking Workshop3Normal Growth and Development (Integrated throughout your nursing education)Basic Human NeedsCoping Mechanisms of IndividualsActual Potential for Health ProblemsEffects on Health Needs of Age, Sex, Culture, Ethnicity and ReligionWays to Assist Clients by Teaching Them to:Maintain HealthCope with Health Problems3Testtaking Workshop4

4Testtaking Workshop5Integrated Process1. Nursing Process2. Caring3. Communication and Documentation 4. Teaching/Learning5Testtaking Workshop6

6Testtaking Workshop71. Assessment2. Analysis 3. Planning 4. Intervention5. Evaluation71. Identify the signs and symptoms most indicative of a deterioration of the clients respiratory status.8Increased restlessness and changes in level of consciousnessBradycardia and increases in blood pressureComplaints of chest pain and shortness of breathRapidly dropping PCO2 and pH81. Identify the signs and symptoms most indicative of a deterioration of the clients respiratory status.Increased restlessness and changes in level of consciousnessBradycardia and increases in blood pressureComplaints of chest pain and shortness of breathRapidly dropping PCO2 and pH

A. The brain is one of the first organs to be affected by a decrease in oxygenation. Restlessness and changes in the level of consciousness indicate this decrease. All the other choices are assessments for other conditions.99Testtaking Workshop101. Assessment2. Analysis 3. Planning 4. Intervention5. Evaluation102. A client is admitted to the unit with a diagnosis of bronchitis, heart failure and fever. The nurse assesses the client to be very nervous, have a temperature of 101.1oF (38.4oC), peripheral edema, dyspnea, and rhonchi. Which nursing diagnosis has the highest priority?11Anxiety related to fear of hospitalizationIneffective airway clearance related to retained secretionsFluid volume excess related to third spacing of fluid (edema)Ineffective thermoregulation related to fever112. A client is admitted to the unit with a diagnosis of bronchitis, heart failure and fever. The nurse assesses the client to be very nervous, have a temperature of 101.1oF (38.4oC), peripheral edema, dyspnea, and rhonchi. Which nursing diagnosis has the highest priority?Anxiety related to fear of hospitalizationIneffective airway clearance related to retained secretionsFluid volume excess related to third spacing of fluid (edema)Ineffective thermoregulation related to fever

B. Nursing diagnoses that deal with the airway always have highest priority.1212Testtaking Workshop131. Assessment2. Analysis 3. Planning 4. Intervention5. Evaluation133. A client is diagnosed with respiratory failure and is placed on oxygen. Select the highest priority goal for this client.14Ambulate the client twice per shift down the length of the hallComplete a bath and morning care before breakfastMaintain an oxygen saturation of 90% throughout the shiftKeep the head of the bed elevated to promote proper ventilation143. A client is diagnosed with respiratory failure and is placed on oxygen. Select the highest priority goal for this client.Ambulate the client twice per shift down the length of the hallComplete a bath and morning care before breakfastMaintain an oxygen saturation of 90% throughout the shiftKeep the head of the bed elevated to promote proper ventilation

C. Choice A is unrealistic for this client. Choice B is not client centered, and choice D is a nursing intervention, not a goal. Maintaining an oxygen saturation of 90% is realistic and within normal limits.1515Testtaking Workshop161. Assessment2. Analysis 3. Planning 4. Intervention5. Evaluation164. When the nurse ambulates a client who has been on bedrest for three days, the client suddenly becomes very restless, displays extreme dyspnea and complains of chest pain. Which is the appropriate immediate nursing action?17Call the physician about the change in the clients conditionContinue to ambulate the client, but at a slower rateGive the client an injection of ordered pain medicationReturn the client to bed, and evaluate vital signs and lung sounds174. When the nurse ambulates a client who has been on bedrest for three days, the client suddenly becomes very restless, displays extreme dyspnea and complains of chest pain. Which is the appropriate immediate nursing action?Call the physician about the change in the clients conditionContinue to ambulate the client, but at a slower rateGive the client an injection of ordered pain medicationReturn the client to bed, and evaluate vital signs and lung sounds

D. These are symptoms of a pulmonary embolism which is a common complication of prolonged bedrest.1818Testtaking Workshop191. Assessment2. Analysis 3. Planning 4. Intervention5. Evaluation195. A client is being prepared for discharge and is to take a theophylline medication by mouth at home for his lung disease. Which client statement indicated that teaching concerning theophylline medications has been effective?20I can stop taking this medication when I feel better.If I have difficulty swallowing the time-released capsules, I can crush or chew them.If I have a lot of nausea and vomiting or become restless and cant sleep, I need to call my physician.I need to drink more coffee and soft drinks while I am on this medication.

205. A client is being prepared for discharge and is to take a theophylline medication by mouth at home for his lung disease. Which client statement indicated that teaching concerning theophylline medications has been effective?I can stop taking this medication when I feel better.If I have difficulty swallowing the time-released capsules, I can crush or chew them.If I have a lot of nausea and vomiting or become restless and cant sleep, I need to call my physician.I need to drink more coffee and soft drinks while I am on this medication.

C. Choice C lists some adverse effects of theophylline medications that may indicate the onset of toxicity. The physician needs to know about these so that the theophylline level can be determined and the dosage adjusted accordingly. Other factors that the client could be taught about theophylline medications include avoiding excessive amounts of caffeine, never suddenly stop taking the medication, take it with a full glass of water and a small amount of food, and watch for interactions with OTC medications.2121Testtaking Workshop22Caring22Testtaking Workshop23CommunicationAnd Documentation23Testtaking Workshop24Teaching/Learning24Testtaking Workshop25

25Testtaking Workshop26Client Needs

I. Safe,Effective Care EnvironmentII. Health Promotion and MaintenanceIII. Psychosocial IntegrityIV. Physiological Integrity26Testtaking Workshop Client Needs27Safe, Effective Care Environment Management of Care Safety & Infection ControlHealth Promotion and MaintenancePsychosocial IntegrityPhysiological Integrity Basic Care and Comfort Pharmacological & Parenteral Therapy Reduction of Risk Potential Physiological Adaptation

13-19% 8-14% 6-12% 6-12%

6-12%13-19%13-19%11-17%

27Testtaking Workshop28Client Needs

I.Safe, Effective Care Environment28Testtaking Workshop29

Client NeedsII. Health Promotion and Maintenance29Testtaking Workshop30

Client NeedsIII. Psychosocial Integrity30Testtaking Workshop31

Client NeedsIV. Physiological Integrity31Testtaking Workshop32

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336. A client is admitted to the medical unit with respiratory failure. What is the normal range for PO2?3410-30 mm Hg35-55 mm Hg10-20 cm H2O80-100 mm Hg346. A client is admitted to the medical unit with respiratory failure. What is the normal range for PO2?10-30 mm Hg35-55 mm Hg10-20 cm H2O80-100 mm Hg

D. You either have or do not have the knowledge for this particular laboratory test.3535Testtaking Workshop36

367. A client is becoming progressively short of breath and the ABGs are: pH-7.13; PO2-48; PCO2-53; HCO3-26. What is indicated by these values?37Uncompensated metabolic acidosis with moderate hypoxiaRespiratory alkalosis with hypoxiaUncompensated respiratory acidosis with severe hypoxiaCompensated respiratory acidosis with normal oxygen

377. A client is becoming progressively short of breath and the ABGs are: pH-7.13; PO2-48; PCO2-53; HCO3-26. What is indicated by these values?Uncompensated metabolic acidosis with moderate hypoxiaRespiratory alkalosis with hypoxiaUncompensated respiratory acidosis with severe hypoxiaCompensated respiratory acidosis with normal oxygen

C. Not only do you have to know the normal values for each of the blood gas components given, you also have to be able to use that information in determining the underlying condition.38388. A client has become cyanotic and is having Cheyne-Stokes respirations. What is the best action for the nurse to take at this time?39Call a code blue and begin CPRCall the physician and report the conditionMake sure the clients airway is open and begin supplemental oxygenGive the ordered dose of 200 mg aminophylline IVPB now398. A client has become cyanotic and is having Cheyne-Stokes respirations. What is the best action for the nurse to take at this time?Call a code blue and begin CPRCall the physician and report the conditionMake sure the clients airway is open and begin supplemental oxygenGive the ordered dose of 200 mg aminophylline IVPB now

C. Answers B and D are also actions that should be carried out, but at this time, opening the airway and oxygenating the client must receive highest priority. Not only does this question require that the nurse know some specific facts (definitions of cyanotic and Cheyne-Stokes respirations), but also requires a decision be made about the seriousness of the condition (analysis) and a selection of the care to be given from several correct options (judgment).4040Testtaking Workshop41

41Testtaking Workshop42Multiple Choice Items42Testtaking Workshop43

43Testtaking Workshop44CAT changes difficulty level for next question based on response to previous question.449. The nurse is instructing a client on how to obtain a 24-hour urine sample for creatinine clearance. Which measure is appropriate for the nurse to include in the teaching plan?45Keep the urine in a glass container onlyDrink extra fluid to increase the amountSave all the urine for a full 24 hoursSave only enough urine to fill the container459. The nurse is instructing a client on how to obtain a 24-hour urine sample for creatinine clearance. Which measure is appropriate for the nurse to include in the teaching plan?Keep the urine in a glass container onlyDrink extra fluid to increase the amountSave all the urine for a full 24 hoursSave only enough urine to fill the container

C. All urine needs to be saved, or the results would be inaccurate. This material should be covered in one of the introductory courses and is considered to have a low difficulty level. 464610. A client has been diagnosed as having Wolff-Parkinson-White (WPW) syndrome, Type A. In evaluating the electrocardiogram, the nurse notes which characteristics for this condition?47PR interval less than 0.12 second and wide QRS complexPR interval greater than 0.20 second and normal QRS complexDelta wave present in a positively deflected QRS complex in lead V1 and PR interval less than 0.12 secondDelta wave present in a positively deflected QRS complex in lead V6 and PR interval greater than 0.20 second4710. A client has been diagnosed as having Wolff-Parkinson-White (WPW) syndrome, Type A. In evaluating the electrocardiogram, the nurse notes which characteristics for this condition?PR interval less than 0.12 second and wide QRS complexPR interval greater than 0.20 second and normal QRS complexDelta wave present in a positively deflected QRS complex in lead V1 and PR interval less than 0.12 secondDelta wave present in a positively deflected QRS complex in lead V6 and PR interval greater than 0.20 second

C. These are the criteria for WPW. This material is much more difficult and usually covered, if at all, toward the end of the educational program. 4848Testtaking Workshop49Alternate Format Items1.Fill-in-the-blank2.Select more than one option3.Identification of an Area/Location within an Image or Graphic4.Ranking or Ordered response5.Charts and Tables49Fill-in-the-Blank50For breakfast, a client consumed the following food and fluids.1 cup of milk10 oz. of water4 oz. of gelatin1 scrambled egg1 crisp piece of bacon2 biscuits with jellyHow many milliliters should the nurse document for the breakfast intake?Answer:______________mL.50Fill-in-the-BlankFor breakfast, a client consumed the following food and fluids.1 cup of milk10 oz. of water4 oz. of gelatin1 scrambled egg1 crisp piece of bacon2 biscuits with jellyHow many milliliters should the nurse document for the breakfast intake?Answer:_____660 or 670 mL.

Correct answer: 660 mL or 670 mL1 cup = 8 fluid ounces (240 or 250 mL, depending on source)10 oz = 300 mL4 oz = 120 mL515152Select more than One OptionIn which situation(s) does the staff demonstrate adherence to infectioncontrol procedures? Select all that apply.___1. Transfers a client who has just been diagnosed with active pulmonary tuberculosis from a semi-private room to a private___2. Initiates airborne precautions, as well as standard precautions, for the client with scabies___3. Utilizes droplet precautions, in addition to standard precautions, with a client who has meningococcal pneumonia___4. Transfers a client with a staphylococcus wound infection to a private room___5. Transfers a client with chicken pox (varicella) from a semi-private room with a postoperative roommate to a semi-private room with a roommate who has rubella___6. In addition to standard precautions, institutes contact precautions for the client whit shigellosis52Select more than One OptionIn which situation(s) does the staff demonstrate adherence to infectioncontrol procedures? Select all that apply._X__1. Transfers a client who has just been diagnosed with active pulmonary tuberculosis from a semi-private room to a private___2. Initiates airborne precautions, as well as standard precautions, for the client with scabies_X__3. Utilizes droplet precautions, in addition to standard precautions, with a client who has meningococcal pneumonia___4. Transfers a client with a staphylococcus wound infection to a private room___5. Transfers a client with chicken pox (varicella) from a semi-private room with a postoperative roommate to a semi-private room with a roommate who has rubella_X__6. In addition to standard precautions, institutes contact precautions for the client whit shigellosis

Correct answer: 1, 3 and 6For the client with pulmonary tuberculosis, a private room, airborne and standard precautions are required. For scabies, contact and standard precautions are required. For pneumonia, droplet and standard precautions are required. A client with a staph wound infection may be in a private room or with a client with the same organism. Chickenpox should be in a private room. Shigellosis needs contact and standard precautions.5353Identification of an Area/Location within an Image or Graphic54The nurse is auscultating a clients breath sounds. Identify the area where the stethoscope should be placed by the nurse to best auscultate bronchovesicular breath sounds. For this item there would be an image of the thorax and the candidate would indicate the position for auscultation by positioning the mouse or cursor on a specific location within the image of the thorax and clicking.54Identification of an Area/Location within an Image or Graphic55

55Ranking or Ordered Response56Prioritize nursing actions for a client with a history of generalized seizures who is beginning to experience a tonic-clonic seizure.

Protect client from injuryDocument the time of seizure occurrenceDetermine airway patencyExplain to significant others what is occurringReassure and reorient the client

Type the correct order by number in the box below without spacesbetween numbers.56Ranking or Ordered ResponsePrioritize nursing actions for a client with a history of generalized seizures who is beginning to experience a tonic-clonic seizure.

Protect client from injuryDocument the time of seizure occurrenceDetermine airway patencyExplain to significant others what is occurringReassure and reorient the client

Type the correct order by number in the box below without spacesbetween numbers.

Correct answer: 312455757Charts and Tables 58You will be asked a question. You will then click on the exhibit button at the bottom and a chart or table with tabs will appear. You will need to click on the appropriate portion to obtain the information you need to answer the question. 58Testtaking Workshop59

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62Testtaking Workshop63Licensure Examination Tests Minimum Standards to Guarantee Public Safety, Not Maximum Ability63Guidelines to Testtaking64

64Guidelines to Testtaking65Look for key words such as age, sex, who client is, any significant others involved, time frame65Guidelines to Testtaking66

66Guidelines to Testtaking67Treat each question individually. There is no reference from one question to another question.67Guidelines to Testtaking68

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69Guidelines to Testtaking70Use the process of elimination in selecting the correct answer70Guidelines to Testtaking71

7111. The nurse suspects that a client is having an anaphylactic-type allergic reaction to an IV antibiotic just received. Which symptoms manifested by the client would most likely lead the nurse to this conclusion?72Nausea and vomitingItchy rash and hivesHypertension and tachycardiaSudden wheezing and urticaria7211. The nurse suspects that a client is having an anaphylactic-type allergic reaction to an IV antibiotic just received. Which symptoms manifested by the client would most likely lead the nurse to this conclusion?Nausea and vomitingItchy rash and hivesHypertension and tachycardiaSudden wheezing and urticaria

D. Anaphylactic reactions cause bronchial spasms/constriction and rashes. Nausea and vomiting are adverse side effects and hypertension is not associated with anaphylactic shock. The graduate may have chosen B if he/she did not read the whole question carefully, but D (urticaria) includes B.7373Guidelines to Testtaking74

74Guidelines to Testtaking75Maslows Hierarchy of Needs

Self-actualizingSelf-esteemLove and BelongingSafety NeedsPhysiologic Needs75Guidelines to Testtaking76

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7712. A 62-year-old client has a history of coronary heart disease and is brought into the ER complaining of chest pain. What initial action should be taken by the nurse?78Give the client nitroglycerin 0.3 mg SL nowCall the clients cardiologist about admissionPlace the client in a high-Fowlers position after loosening the shirtCheck B/P and note the location and degree of the chest pain7812. A 62-year-old client has a history of coronary heart disease and is brought into the ER complaining of chest pain. What initial action should be taken by the nurse?Give the client nitroglycerin 0.3 mg SL nowCall the clients cardiologist about admissionPlace the client in a high-Fowlers position after loosening the shirtCheck B/P and note the location and degree of the chest pain

D. It is important to remember that when asked for an initial or first action, think of the nursing process. The first step in the nursing process is always assessment. If there is not an assessment choice, then look for a planning choice and so forth. The other three answers provided for this question are also correct and should be done at some point; but in this particular situation, the first need is to assess the chest pain to determine if it is indeed cardiac in nature. Many other conditions also cause chest pain.7979Guidelines to Testtaking80

8013. Select the medication that is inappropriate for the relief of chest pain.81Diltiazem (Cardizem)Propranolol (Inderal)Digoxin (Lanoxin)Meperidine (Demerol)8113. Select the medication that is inappropriate for the relief of chest pain.Diltiazem (Cardizem)Propranolol (Inderal)Digoxin (Lanoxin)Meperidine (Demerol)

C. Digoxin is a positive inotropic medication and increases contractility and the oxygen demands of the heart. It is likely it would actually increase chest pain in this client. The other three medications all relieve chest pain by somewhat different mechanisms. But notice that if the question was not read carefully and the reader missed the in prefix of inappropriate then certainly choice C would not have been selected.8282Guidelines to Testtaking83

8314. When assessing the chest pain of a client with cardiovascular disease, what may be considered?84This pain is always caused by constriction or blockage of the coronary arteries by fat plaques or blood clotsTrue cardiac pain is never relieved without treatmentThis type of pain is only relieved by nitroglycerinClients often attribute the pain to indigestion8414. When assessing the chest pain of a client with cardiovascular disease, what may be considered?This pain is always caused by constriction or blockage of the coronary arteries by fat plaques or blood clotsTrue cardiac pain is never relieved without treatmentThis type of pain is only relieved by nitroglycerinClients often attribute the pain to indigestion

D. The answers to this question are very obvious in the demonstration of the avoid the absolute strategy. Coronary type chest pain can also be caused by spasms of the coronary arteries as a variant angina (choice A). Chest pain sometimes can go away by itself, although it will probably return later (choice B). There are a number of medications that will also relieve chest pain besides nitroglycerin (e.g. morphine and narcotics, calcium-channel blockers and beta blockers) (choice C).8585Guidelines to Testtaking86

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8715. A client has developed heart failure. Identify the correct loading dose of digoxin (Lanoxin) for an adult client.880.75 mg divided into three doses q 8 hours0.75 Gm divided into four doses q 8 hours10 mg due to the fact the client is a very large person, with a Native American background, which causes slow absorption of the medication0.25 mg8815. A client has developed heart failure. Identify the correct loading dose of digoxin (Lanoxin) for an adult client.0.75 mg divided into three doses q 8 hours0.75 Gm divided into four doses q 8 hours10 mg due to the fact the client is a very large person, with a Native American background, which causes slow absorption of the medication0.25 mg

A. The loading dose for digoxin is usually three times the maintenance dose (0.25 mg) divided over 24 hours. Choice B is in a different measurement form (grams instead of milligrams); choice C demonstrates the longer than average answer with rationale; and D is much shorter than any of the others.8989Guidelines to Testtaking90

90Guidelines to Testtaking91Avoid looking for a pattern in the selection of answers9116. A 33-year-old client has been diagnosed as having a pheochromocytoma. Select the appropriate initial nursing activity.93Administer large doses of xylometrazoline (Otrivin) to help control the symptoms of the diseaseMonitor the clients vital signs closely, particularly the blood pressurePrepare the client and family for imminent deathHave the family discuss the condition with the physician before informing the client about the disease because of the protracted recovery period after treatment. 9316. A 33-year-old client has been diagnosed as having a pheochromocytoma. Select the appropriate initial nursing activity.Administer large doses of xylometrazoline (Otrivin) to help control the symptoms of the diseaseMonitor the clients vital signs closely, particularly the blood pressurePrepare the client and family for imminent deathHave the family discuss the condition with the physician before informing the client about the disease because of the protracted recovery period after treatment.

B. A pheochromocytoma is a tumor of the adrenal medulla that causes an increase in the secretion of epinephrine and/or norepinephrine. One important result of having this type of tumor is that a hypertensive crisis may occur in some individuals. Monitoring B/P would be an important nursing care measure. Also, assessment is the first step of the nursing process and would fit well with the qualifying word initial, used in the question stem. (xylometrazoline [Otrivin} is similar to Neosynephrine)9494Guidelines to Testtaking95

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97Guidelines to Testtaking98Choose answers that acknowledge the client, communicate acceptance, are open-ended and encourage discussion and expression of feelings98Guidelines to Testtaking99If two or three answers say the same thing in different words, none are right99Guidelines to Testtaking100Look for the type of answer required (assessment data, nursing intervention, prioritizing, etc.)100Guidelines to Testtaking101

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102Guidelines to Testtaking103Review ThoroughlyNames of Common MedicationsLethal and Therapeutic Doses and AntidotesCommon Side Effects of MedicationsLab Values and ImplicationsGrowth and DevelopmentDiet TherapyBasic Anatomy and PhysiologyStages of the Nursing Process103Guidelines to Testtaking104

104Guidelines to Testtaking105Group Study Rules Set time limits Divide responsibilities of review Prepare your own questions Make decisions on participants Stop at scheduled end105Guidelines to Testtaking106

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111Guidelines to Testtaking112Avoid Stimulants and Alcohol112Guidelines to Testtaking113

113Guidelines to Testtaking114Day of Exam Avoid excess oral intake of your special diuretics: Coffee, Cigarettes, Tea, Soft Drinks. Do increase intake of foods high in quality glucose and protein. Arrive 15 to 30 minutes early. Relaxation Technique114Guidelines to Testtaking115

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