NCLEX RN Practice Test 5
Increases fitness and prevents future heart
1. A nurse is administering IV furosemide to a
patient admitted with congestive heart failure.
After the infusion, which of the following
symptoms is NOT expected?
A. Increased urinary output.
B. Decreased edema.
C. Decreased pain.
D. Decreased blood pressure.
2. There are a number of risk factors associated
with coronary artery disease. Which of the
following is a modifiable risk factor?
A. Obesity.
B. Heredity.
C. Gender.
D. Age.
3. Tissue plasminogen activator (t-PA) is
considered for treatment of a patient who arrives
in the emergency department following onset of
symptoms of myocardial infarction. Which of
the following is a contraindication for treatment
with t-PA?
A. Worsening chest pain that began earlier in the
evening.
B. History of cerebral hemorrhage.
C. History of prior myocardial infarction.
D. Hypertension.
4. Following myocardial infarction, a
hospitalized patient is encouraged to practice
frequent leg exercises and ambulate in the
hallway as directed by his physician. Which of
the following choices reflects the purpose of
exercise for this patient?
A.
attacks.
B. Prevents bedsores.
C. Prevents DVT (deep vein thrombosis).
D. Prevent constipations.
5. A patient arrives in the emergency department
with symptoms of myocardial infarction,
progressing to cardiogenic shock. Which of the
following symptoms should the nurse expect the
patient to exhibit with cardiogenic shock?
A. Hypertension.
B. Bradycardia.
C. Bounding pulse.
D. Confusion.
6. A patient with a history of congestive heart
failure arrives at the clinic complaining of
dyspnea. Which of the following actions is the
first the nurse should perform?
A. Ask the patient to lie down on the exam table.
B. Draw blood for chemistry panel and arterial
blood gas (ABG).
C. Send the patient for a chest x-ray.
D. Check blood pressure.
7. A clinic patient has recently been prescribed
nitroglycerin for treatment of angina. He calls
the nurse complaining of frequent headaches.
Which of the following responses to the patient
is correct?
A. "Stop taking the nitroglycerin and see if the
headaches improve."
B. "Go to the emergency department to be
checked because nitroglycerin can cause
bleeding in the brain."
C. "Headaches are a frequent side effect of
nitroglycerine because it causes vasodilation."
D. "The headaches are unlikely to be related to
the nitroglycerin, so you should see your doctor
for further investigation."
8. A patient received surgery and chemotherapy
for colon cancer, completing therapy 3 months
previously, and she is now in remission. At a
follow-up appointment, she complains of fatigue
following activity and difficulty with
concentration at her weekly bridge games.
Which of the following explanations could
account for her symptoms?
A. The symptoms may be the result of anemia
caused by chemotherapy.
B. The patient may be immunosuppressed.
C. The patient may be depressed.
D. The patient may be dehydrated.
9. A clinic patient has a hemoglobin
concentration of 10.8 g/dL and reports sticking
to a strict vegetarian diet. Which of the follow
nutritional advice is appropriate?
A. The diet is providing adequate sources of iron
and requires no changes.
B. The patient should add meat to her diet; a
vegetarian diet is not advised.
C. The patient should use iron cookware to
prepare foods, such as dark green, leafy
vegetables and legumes, which are high in iron.
D. A cup of coffee or tea should be added to
every meal.
10. A hospitalized patient is receiving packed
red blood cells (PRBCs) for treatment of severe
anemia. Which of the following is the most
accurate statement?
A. Transfusion reaction is most likely
immediately after the infusion is completed.
B. PRBCs are best infused slowly through a 20g.
IV catheter.
C. PRBCs should be flushed with a 5% dextrose
solution.
D. A nurse should remain in the room during the
first 15 minutes of infusion.
11. A patient who has received chemotherapy
for cancer treatment is given an injection of
Epoetin. Which of the following should reflect
the findings in a complete blood count (CBC)
drawn several days later?
A. An increase in neutrophil count.
B. An increase in hematocrit.
C. An increase in platelet count.
D. An increase in serum iron.
12. A patient is admitted to the hospital with
suspected polycythemia vera. Which of the
following symptoms is consistent with the
diagnosis?
A. Weight loss.
B. Increased clotting time.
C. Hypertension.
D. Headaches.
13. A nurse is caring for a patient with a platelet
count of 20,000/microliter. Which of the
following is an important intervention?
A. Observe for evidence of spontaneous
bleeding.
B. Limit visitors to family only.
C. Give aspirin in case of headaches.
D. Impose immune precautions.
14. A nurse in the emergency department
assesses a patient who has been taking long-term
corticosteroids to treat renal disease. Which of
the following is a typical side effect of
corticosteroid treatment? Note: More than one
answer may be correct.
A. Hypertension.
B. Cushingoid features.
C. Hyponatremia.
D. Low serum albumin.
15. A nurse is caring for patients in the oncology
unit. Which of the following is the most
important nursing action when caring for a
neutropenic patient?
A. Change the disposable mask immediately
after use.
B. Change gloves immediately after use.
C. Minimize patient contact.
D. Minimize conversation with the patient.
16. A patient is undergoing the induction stage
of treatment for leukemia. The nurse teaches
family members about infectious precautions.
Which of the following statements by family
members indicates that the family needs more
education?
A. We will bring in books and magazines for
entertainment.
B. We will bring in personal care items for
comfort.
C. We will bring in fresh flowers to brighten the
room.
D. We will bring in family pictures and get well
cards.
17. A nurse is caring for a patient with acute
lymphoblastic leukemia (ALL). Which of the
following is the most likely age range of the
patient?
A. 3-10 years.
B. 25-35 years.
C. 45-55 years.
D. over 60 years.
18. A patient is admitted to the oncology unit for
diagnosis of suspected Hodgkin's disease. Which
of the following symptoms is typical of
Hodgkin's disease?
A. Painful cervical lymph nodes.
B. Night sweats and fatigue.
C. Nausea and vomiting.
D. Weight gain.
19. The Hodgkin's disease patient described in
the question above undergoes a lymph node
biopsy for definitive diagnosis. If the diagnosis
of Hodgkin's disease were correct, which of the
following cells would the pathologist expect to
find?
A. Reed-Sternberg cells.
B. Lymphoblastic cells.
C. Gaucher's cells.
D. Rieder's cells
20. A patient is about to undergo bone marrow
aspiration and biopsy and expresses fear and
anxiety about the procedure. Which of the
following is the most effective nursing
response?
A. Warn the patient to stay very still because the
smallest movement will increase her pain.
B. Encourage the family to stay in the room for
the procedure.
C. Stay with the patient and focus on slow, deep
breathing for relaxation.
D. Delay the procedure to allow the patient to
deal with her feelings.
Answer Key
1. Answer: C
Furosemide, a loop diuretic, does not alter pain.
Furosemide acts on the kidneys to increase
urinary output. Fluid may move from the
periphery, decreasing edema. Fluid load is
reduced, lowering blood pressure.
2. Answer: A
Obesity is an important risk factor for coronary
artery disease that can be modified by improved
diet and weight loss. Family history of coronary
artery disease, male gender, and advancing age
increase risk but cannot be modified.
3. Answer: B
A history of cerebral hemorrhage is a
contraindication to tPA because it may increase
the risk of bleeding. TPA acts by dissolving the
clot blocking the coronary artery and works best
when administered within 6 hours of onset of
symptoms. Prior MI is not a contraindication to
tPA. Patients receiving tPA should be observed
for changes in blood pressure, as tPA may cause
hypotension.
4. Answer: C
Exercise is important for all hospitalized patients
to prevent deep vein thrombosis. Muscular
contraction promotes venous return and prevents
hemostasis in the lower extremities. This
exercise is not sufficiently vigorous to increase
physical fitness, nor is it intended to prevent
bedsores or constipation.
5. Answer: D
Cardiogenic shock severely impairs the pumping
function of the heart muscle, causing diminished
blood flow to the organs of the body. This
results in diminished brain function and
confusion, as well as hypotension, tachycardia,
and weak pulse. Cardiogenic shock is a serious
complication of myocardial infarction with a
high mortality rate.
6. Answer: D
A patient with congestive heart failure and
dyspnea may have pulmonary edema, which can
cause severe hypertension. Therefore, taking the
patient's blood pressure should be the first
action. Lying flat on the exam table would likely
worsen the dyspnea, and the patient may not
tolerate it. Blood draws for chemistry and ABG
will be required, but not prior to the blood
pressure assessment.
7. Answer: C
Nitroglycerin is a potent vasodilator and often
produces unwanted effects such as headache,
dizziness, and hypotension. Patients should be
counseled, and the dose titrated, to minimize
these effects. In spite of the side effects,
nitroglycerine is effective at reducing
myocardial oxygen consumption and increasing
blood flow. The patient should not stop the
medication. Nitroglycerine does not cause
bleeding in the brain.
8. Answer: A
Three months after surgery and chemotherapy
the patient is likely to be feeling the after-
effects, which often includes anemia because of
bone-marrow suppression. There is no evidence
that the patient is immunosuppressed, and
fatigue is not a typical symptom of
immunosuppression. The information given does
not indicate that depression or dehydration is a
cause of her symptoms.
9. Answer: 3
Normal hemoglobin values range from 11.5-
15.0. This vegetarian patient is mildly anemic.
When food is prepared in iron cookware its iron
content is increased. In addition, dark green
leafy vegetables, such as spinach and kale, and
legumes are high in iron. Mild anemia does not
require that animal sources of iron be added to
the diet. Many non-animal sources are available.
Coffee and tea increase gastrointestinal activity
and inhibit absorption of iron.
10. Answer: D
Transfusion reaction is most likely during the
first 15 minutes of infusion, and a nurse should
be present during this period. PRBCs should be
infused through a 19g or larger IV catheter to
avoid slow flow, which can cause clotting.
PRBCs must be flushed with 0.45% normal
saline solution. Other intravenous solutions will
hemolyze the cells.
11. Answer: B
Epoetin is a form of erythropoietin, which
stimulates the production of red blood cells,
causing an increase in hematocrit. Epoetin is
given to patients who are anemic, often as a
result of chemotherapy treatment. Epoetin has
no effect on neutrophils, platelets, or serum iron.
12. Answer: B, C, and D
Polycythemia vera is a condition in which the
bone marrow produces too many red blood cells.
This causes an increase in hematocrit and
viscosity of the blood. Patients can experience
headaches, dizziness, and visual disturbances.
Cardiovascular effects include increased blood
pressure and delayed clotting time. Weight loss
is not a manifestation of polycythemia vera.
13. Answer: A
Platelet counts under 30,000/microliter may
cause spontaneous petechiae and bruising,
particularly in the extremities. When the count
falls below 15,000, spontaneous bleeding into
the brain and internal organs may occur.
Headaches may be a sign and should be watched
for. Aspirin disables platelets and should never
be used in the presence of thrombocytopenia.
Thrombocytopenia does not compromise
immunity, and there is no reason to limit visitors
as long as any physical trauma is prevented.
14. Answer: A, B, and D
Side effects of corticosteroids include weight
gain, fluid retention with hypertension,
Cushingoid features, a low serum albumin, and
suppressed inflammatory response. Patients are
encouraged to eat a diet high in protein,
vitamins, and minerals and low in sodium.
Corticosteroids cause hypernatremia, not
hyponatremia.
15. Answer: B
The neutropenic patient is at risk of infection.
Changing gloves immediately after use protects
patients from contamination with organisms
picked up on hospital surfaces. This
contamination can have serious consequences
for an immunocompromised patient. Changing
the respiratory mask is desirable, but not nearly
as urgent as changing gloves. Minimizing
contact and conversation are not necessary and
may cause nursing staff to miss changes in the
patient's symptoms or condition.
16. Answer: C
During induction chemotherapy, the leukemia
patient is severely immunocompromised and at
risk of serious infection. Fresh flowers, fruit, and
plants can carry microbes and should be
avoided. Books, pictures, and other personal
items can be cleaned with antimicrobials before anxiety as well as her own. Delaying the
being brought into the room to minimize the risk procedure is unlikely to allay her fears.
of contamination.

17. Answer: A

The peak incidence of ALL is at 4 years (range

3-10). It is uncommon after the mid-teen years.
The peak incidence of chronic myelogenous
leukemia (CML) is 45-55 years. The peak
incidence of acute myelogenous leukemia
(AML) occurs at 60 years. Two-thirds of cases
of chronic lymphocytic leukemia (CLL) occur
after 60 years.

18. Answer: B

Symptoms of Hodgkin's disease include night

sweats, fatigue, weakness, and tachycardia. The
disease is characterized by painless, enlarged
cervical lymph nodes. Weight loss occurs early
in the disease. Nausea and vomiting are not
typically symptoms of Hodgkin's disease.

19. Answer: A

A definitive diagnosis of Hodgkin's disease is

made if Reed-Sternberg cells are found on
pathologic examination of the excised lymph
node. Lymphoblasts are immature cells found in
the bone marrow of patients with acute
lymphoblastic leukemia. Gaucher's cells are
large storage cells found in patients with
Gaucher's disease. Rieder's cells are myeloblasts
found in patients with acute myelogenous
leukemia.

20. Answer: C

Slow, deep breathing is the most effective

method of reducing anxiety and stress. It reduces
the level of carbon dioxide in the brain to
increase calm and relaxation. Warning the
patient to remain still will likely increase her
anxiety. Encouraging family members to stay
with the patient may make her worry about their