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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Document preview page 1

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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions)

Build exam confidence with NCLEX Critical Care Practice Exam With Answers, featuring a selection of past test questions.

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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 1 preview imageNCLEX-PN Test-Bank (200 Questions with Answers and Explanation)1.The nurse is caring for a client scheduled for removal of a pituitary tumor using thetranssphenoidal approach. The nurse should be particularly alert for:A.Nasal congestionB.Abdominal tendernessC.Muscle tetanyD.OliguriaAnswer A: Removal of the pituitary gland is usually done by a transsphenoidal approach,through the nose. Nasal congestion further interferes with the airway. Answers B, C, and D arenot correct because they are not directly associated with the pituitary gland.2.A client with cancer is admitted to the oncology unit. Stat lab values reveal Hgb 12.6,WBC 6500, K+ 1.9, uric acid 7.0, Na+ 136, and platelets 178,000. The nurse evaluates that theclient is experiencing which of the following?A.HypernatremiaB.HypokalemiaC.MyelosuppressionD.LeukocytosisAnswer B: Hypokalemia is evident from the lab values listed. The other laboratory findings arewithin normal limits, making answers A, C, and Dincorrect.
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 2 preview image
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 3 preview image3.A 24-year-old female client is scheduled for surgery in the morning. Which of thefollowing is the primary responsibility of the nurse?A.Taking the vital signsB.Obtaining the permitC.Explaining the procedureD.Checking the lab workAnswer A: The primary responsibility of the nurse is to take the vital signs before any surgery.The actions in answers B, C, and D are the responsibility of the doctor and, therefore, areincorrect for this question.4.The nurse is working in the emergency room when a client arrives with severe burns ofthe left arm, hands, face, and neck. Which action should receive priority?A.Starting an IVB.Applying oxygenC.Obtaining blood gasesD.Medicating the client for painAnswer B: The client with burns to the neck needs airway assessment and supplemental oxygen,so applying oxygen is the priority. The next action should be to start an IV and medicate for pain,making answers A and C incorrect. Answer D, obtaining blood gases, is ordered by the doctor.5.The nurse is visiting a home health client with osteoporosis. The client has a newprescription for alendronate (Fosamax). Which instruction should be given to the client?A.Rest in bed after taking the medication for at least 30 minutesB.Avoid rapid movements after taking the medicationC.Take the medication with water only
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 4 preview imageD.Allow at least 1 hour between taking the medicine and taking other medicationsAnswer B: The client with burns to the neck needs airway assessment and supplemental oxygen,so applying oxygen is the priority. The next action should be to start an IV and medicate for pain,making answers A and C incorrect. Answer D, obtaining blood gases, is ordered by the doctor.6.The nurse is making initial rounds on a client with a C5 fracture and crutchfield tongs.Which equipment should be kept at the bedside?A.A pair of forcepsB.A torque wrenchC.A pair of wire cuttersD.A screwdriverAnswer B: A torque wrench is kept at the bedside to tighten and loosen the screws of crutchfieldtongs. This wrench controls the amount of pressure that is placed on the screws. A pair offorceps, wire cutters, and a screwdriver, in answers A, C, and D, would not be used and, thus, areincorrect.7.An infant weighs 7 pounds at birth. The expected weight by 1 year shouldbe:A.10 poundsB.12 poundsC.18 poundsD.21 pounds
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 5 preview imageAnswer D: A birth weight of 7 pounds would indicate 21 pounds in 1 year, or triple his birthweight. Answers A, B, and C therefore are incorrect.8.A client is admitted with a Ewing’s sarcoma. Which symptoms would be expected due tothis tumor’s location?A.HemiplegiaB.AphasiaC.NauseaD.Bone painAnswer D: Sarcoma is a type of bone cancer; therefore, bone pain would be expected. AnswersA, B, and C are not specific to this type of cancer and are incorrect.9.The nurse is caring for a client with epilepsy who is being treated with carbamazepine(Tegretol). Which laboratory value might indicate a serious side effect of this drug?A.Uric acid of 5mg/dLB.Hematocrit of 33%C.WBC 2,000 per cubic millimeterD.Platelets 150,000 per cubic millimeterAnswer C: Tegretol can suppress the bone marrow and decrease the white blood cell count; thus,a lab value of WBC 2,000 per cubic millimeter indicates side effects of the drug. Answers A andD are within normal limits, and answer B is a lower limit of normal; therefore, answers A, B, andD are incorrect.
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 6 preview image10.A 6-month-old client is admitted with possible intussuception. Which question during thenursing history is least helpful in obtaining information regarding this diagnosis?A.“Tell me about his pain.”B.“What does his vomit look like?”C.“Describe his usual diet.”D.“Have you noticed changes in his abdominal size?”Answer C: The least-helpful questions are those describing his usual diet. A, B, and D are usefulin determining the extent of disease process and, thus, are incorrect.11.The nurse is assisting a client with diverticulosis to select appropriate foods. Which foodshould be avoided?A.BranB.Fresh peachesC.Cucumber saladD.Yeast rollsAnswer C: The client with diverticulitis should avoid foods with seeds. The foods in answers A,B, and D are allowed; in fact, bran cereal and fruit will help prevent constipation.12.A client has rectal cancer and is scheduled for an abdominal perineal resection. Whatshould be the priority nursing care during the post-op period?A.Teaching how to irrigate the illeostomyB.Stopping electrolyte loss in the incisional areaC.Encouraging a high-fiber diet
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 7 preview imageD.Facilitating perineal wound drainageAnswer D: The client with a perineal resection will have a perineal incision. Drains will be usedto facilitate wound drainage. This will help prevent infection of the surgical site. The client willnot have an illeostomy, as in answer A; he will have some electrolyte loss, but treatment is notfocused on preventing the loss, so answer B is incorrect. A high-fiber diet, in answer C, is notordered at this time.13.The nurse is performing discharge teaching on a client with diverticulitis who has beenplaced on a low-roughage diet. Which food would have to be eliminated from this client’s diet?A.Roasted chickenB.NoodlesC.Cooked broccoliD.CustardAnswer C: The client with diverticulitis should avoid eating foods that aregas forming and that increase abdominal discomfort, such as cooked broccoli. Foods such asthose listed in answers A, B, and D are allowed.14.The nurse is caring for a new mother. The mother asks why her baby has lost weightsince he was born. The best explanation of the weight loss is:A.The baby is dehydrated due to polyuria.B.The baby is hypoglycemic due to lack of glucose.C.The baby is allergic to the formula the mother is giving him.D.The baby can lose up to 10% of weight due to meconium stool, loss of extracellular fluid,and initiation of breast-feeding.
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 8 preview imageAnswer D: After birth, meconium stool, loss of extracellular fluid, and initiation of breastfeedingcause the infant to lose body mass. There is no evidence to indicate dehydration, hypoglycemia,or allergy to the infant formula; thus, answers A, B, and C are incorrect.15.The nurse is caring for a client with laryngeal cancer. Which finding ascertained in thehealth history would not be common for this diagnosis?A.Foul breathB.DysphagiaC.DiarrheaD.Chronic hiccupsAnswer C: Diarrhea is not common in clients with mouth and throat cancer. All the findings inanswers A, B, and D are expected findings.16.A removal of the left lower lobe of the lung is performed on a client with lung cancer.Which post-operative measure would usually be included in the plan?A.Closed chest drainageB.A tracheostomyC.A mediastinal tubeD.Percussion vibration and drainageAnswer A: The client with a lung resection will have chest tubes and a drainage-collectiondevice. He probably will not have a tracheostomy or mediastinal tube, and he will not have anorder for percussion, vibration, or drainage. Therefore, answers B, C, and D are incorrect.
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 9 preview image17.Six hours after birth, the infant is found to have an area of swelling over the right parietalarea that does not cross the suture line. The nurse should chart this finding as:A.A cephalohematomaB.MoldingC.Subdural hematomaD.Caput succedaneumAnswer A: A swelling over the right parietal area is a cephalohematoma, an area of bleedingoutside the cranium. This type of hematoma does not cross the suture line because it is outsidethe cranium but beneath the periosteum. Answer B, molding, is overlapping of the bones of thecranium and, thus, incorrect. In answer C, a subdural hematoma, or intracranial bleeding, isominous and can be seen only on a CAT scan or x-ray. A caput succedaneum, in answer D,crosses the suture line and is edema.18.The nurse is assisting the RN with discharge instructions for a client with an implantabledefibrillator. What discharge instruction is essential?A.“You cannot eat food prepared in a microwave.”B.“You should avoid moving the shoulder on the side of the pacemaker site for 6 weeks.”C.“You should use your cellphone on your right side.”D.“You will not be able to fly on a commercial airliner with the defibrillator in place.”Answer C: The client with an internal defibrillator should learn to use any battery-operatedmachinery on the opposite side. He should also take his pulse rate and report dizziness orfainting. Answers A, B, and D are incorrect because the client can eat food prepared in themicrowave, move his shoulder on the affected side, and fly in an airplane.19.A client in the cardiac step-down unit requires suctioning for excess mucous secretions.The nurse should be most careful to monitor the client for which dysrhythmia during thisprocedure?
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 10 preview imageA.BradycardiaB.TachycardiaC.Premature ventricular beatsD.Heart blockAnswer A: Suctioning can cause a vagal response and bradycardia. Answer B is unlikely and,therefore, not most important, although it can occur.Answers C and D can occur as well, but they are less likely.20.The nurse is caring for a client scheduled for a surgical repair of a sacular abdominalaortic aneurysm. Which assessment is most crucial during the preoperative period?A.Assessment of the client’s level of anxietyB.Evaluation of the client’s exercise toleranceC.Identification of peripheral pulsesD.Assessment of bowel sounds and activityAnswer C: The assessment that is most crucial to the client is the identification of peripheralpulses because the aorta is clamped during surgery. This decreases blood circulation to thekidneys and lower extremities. The nurse must also assess for the return of circulation to thelower extremities. Answer A is of lesser concern, answer B is not advised at this time, andanswer D is of lesser concern than answer A.21.A client with suspected renal disease is to undergo a renal biopsy. The nurse plans toinclude which statement in the teaching session?A.“You will be sitting for the examination procedure.”B.“Portions of the procedure will cause pain or discomfort.”C.“You will be given some medication to anesthetize the area.”
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 11 preview imageD.“You will not be able to drink fluids for 24 hours before the study.”Answer B: Portions of the exam are painful, especially when the sample is being withdrawn, sothis should be included in the session with the client. Answer A is incorrect because the clientwill be positioned prone, not in a sitting position, for the exam. Anesthesia is not commonlygiven before this test, making answer C incorrect. Answer D is incorrect because the client caneat and drink following the test.22.The nurse is performing an assessment on a client with possible pernicious anemia.Which data would support this diagnosis?A.A weight loss of 10 pounds in 2 weeksB.Complaints of numbness and tingling in the extremitiesC.A red, beefy tongueD.A hemoglobin level of 12.0gm/dLAnswer C: A red, beefy tongue is characteristic of the client with pernicious anemia. Answer A, aweight loss of 10 pounds in 2 weeks, is abnormal but is not seen in pernicious anemia.Numbness and tingling, in answer B, can be associated with anemia but are not particular topernicious anemia. This is more likely associated with peripheral vascular diseases involvingvasculature. In answer D, the hemoglobin is low normal.23.A client arrives in the emergency room with a possible fractured femur. The nurse shouldanticipate an order for:A.Trendelenburg positionB.Ice to the entire extremityC.Buck’s tractionD.An abduction pillow
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 12 preview imageAnswer C: The client with a fractured femur will be placed in Buck’s traction to realign the legand to decrease spasms and pain. The Trendelenburg position is the wrong position for thisclient, so answer A is incorrect. Ice might be ordered after repair, but not for the entire extremity,so answer B is incorrect. An abduction pillow is ordered after a total hip replacement, not for afractured femur; therefore, answer D is incorrect.24.A client with cancer is to undergo an intravenous pyelogram. The nurse should:A.Force fluids 24 hours before the procedureB.Ask the client to void immediately before the studyC.Hold medication that affects the central nervous system for 12 hours pre- and post-testD.Cover the client’s reproductive organs with an x-ray shieldAnswer B: The client having an intravenous pyelogram will have orders for laxatives or enemas,so asking the client to void before the test is in order. A full bladder or bowel can obscure thevisualization of the kidney ureters and urethra. In answers A, C, and D, there is no need to forcefluids before the procedure, to withhold medications, or to cover the reproductive organs.25.The nurse is caring for a client with a malignancy. The classification of the primary tumoris Tis. The nurse should plan care for a tumor:A.That cannot be assessedB.That is in situC.With increasing lymph node involvementD.With distant metastasisAnswer B: Cancer in situ means that the cancer is still localized to the primary site. Cancer isgraded in terms of tumor, grade, node involvement, and mestatasis. Answer A is incorrectbecause it is an untrue statement.Answer C is incorrect because T indicates tumor, not node involvement. Answer D is incorrectbecause a tumor that is in situ is not metastasized.
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 13 preview image26.A client is 2 days post-operative colon resection. After a coughing episode, the client’swound eviscerates. Which nursing action is most appropriate?A.Reinsert the protruding organ and cover with 4×4sB.Cover the wound with a sterile 4×4 and ABD dressingC.Cover the wound with a sterile saline-soaked dressingD.Apply an abdominal binder and manual pressure to the woundAnswer C: If the client eviscerates, the abdominal content should be covered with a sterilesaline-soaked dressing. Reinserting the content should not be the action and will require that theclient return to surgery; thus, answer A is incorrect. Answers B and D are incorrect because theyare not appropriate to this case.27.The nurse is preparing a client for surgery. Which item is most important to removebefore sending the client to surgery?A.Hearing aidB.Contact lensesC.Wedding ringD.Artificial eyeAnswer B: It is most important to remove the contact lenses because leaving them in can lead tocorneal drying, particularly with contact lenses that are not extended-wear lenses. Leaving in thehearing aid or artificial eye will not harm the client. Leaving the wedding ring on is also allowed;usually, the ring is covered with tape. Therefore, answers A, C, and D are incorrect.28.The nurse on the 3–11 shift is assessing the chart of a client with an abdominal aneurysmscheduled for surgery in the morning and finds that the consent form has been signed, but theclient is unclear about the surgery and possible complications. Which is the most appropriateaction?
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 14 preview imageA.Call the surgeon and ask him or her to see the client to clarify the informationB.Explain the procedure and complications to the clientC.Check in the physician’s progress notes to see if understanding has been documentedD.Check with the client’s family to see if they understand the procedure fullyAnswer A: It is the responsibility of the physician to explain and clarify the procedure to theclient. Answers B, C, and D are incorrect because they are not within the nurse’s purview.29.When assessing a client for risk of hyperphosphatemia, which piece of information ismost important for the nurse to obtain?A.A history of radiation treatment in the neck regionB.A history of recent orthopedic surgeryC.A history of minimal physical activityD.A history of the client’s food intakeAnswer A: Previous radiation to the neck might have damaged the parathyroid glands, which arelocated on the thyroid gland, and interfered with calcium and phosphorus regulation. Answer Bhas no significance to this case; answers C and D are more related to calcium only, not tophosphorus regulation.30.A client is admitted to the acute care unit. Initial laboratory values reveal serum sodiumof 170meq/L. What behavior changes would be most common for this client?A.AngerB.ManiaC.DepressionD.Psychosis
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 15 preview imageAnswer B: The client with serum sodium of 170meq/L has hypernatremia and might exhibitmanic behavior. Answers A, C, and D are not associated with hypernatremia and are, therefore,incorrect.31.The nurse is obtaining a history of an 80-year-old client. Which statement made by theclient might indicate a possible fluid and electrolyte imbalance?A.“My skin is always so dry.”B.“I often use a laxative for constipation.”C.“I have always liked to drink a lot of ice tea.”D.“I sometimes have a problem with dribbling urine.”Answer B: Frequent use of laxatives can lead to diarrhea and electrolyte loss. Answers A, C, andD are not of particular significance in this case and, therefore, are incorrect.32.A client visits the clinic after the death of a parent. Which statement made by the client’ssister signifies abnormal grieving?A.“My sister still has episodes of crying, and it’s been 3 months since Daddydied.”B.“Sally seems to have forgotten the bad things that Daddy did in his lifetime.”C.“She really had a hard time after Daddy’s funeral. She said that she had a sense oflonging.”D.“Sally has not been sad at all by Daddy’s death. She acts like nothing has happened.”
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NCLEX Critical Care Practice Exam With Answers (200 Solved Questions) - Page 16 preview imageAnswer D: Abnormal grieving is exhibited by a lack of feeling sad; if the client’s sister appearsnot to grieve, it might be abnormal grieving. This family member might be suppressing feelingsof grief. Answers A, B, and C are all normal expressions of grief and, therefore, incorrect.33.The nurse recognizes that which of the following would be most appropriate to wearwhen providing direct care to a client with a cough?A.MaskB.GownC.GlovesD.Shoe coversAnswer A: If the nurse is exposed to the client with a cough, the best item to wear is a mask. Ifthe answer had included a mask, gloves, and a gown, all would be appropriate, but in this case,only one item is listed; therefore, answers B and C are incorrect. Shoe covers are not necessary,so answer D is incorrect.34.The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis.Which would be the most appropriate nursing intervention?A.Suggest that the client take warm showers B.I.D.B.Add baby oil to the client’s bath waterC.Apply powder to the client’s skinD.Suggest a hot-water rinse after bathingAnswer B: Oils can be applied to help with the dry skin and to decrease itching, so adding babyoil to bath water is soothing to the skin. Answer A is incorrect because bathing twice a day is toofrequent and can cause more dryness. Answer C is incorrect because powder is also drying.Rinsing with hot water, as stated in answer D, dries out the skin as well.
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