Example NCLEX RN Exam 2019 / 2020 / 2021 30th Edition
Example NCLEX RN Exam 2019 / 2020 / 2021 30th Edition
1. A client began taking amantadine (Symmetrel) approximately 2 weeks ago. The nurse would conclude that the medication was having a therapeutic effect if the client exhibited decreased:
A. White blood cell count
B. Voiding
C. Rigidity and akinesia
D. Blood pressure
Answer: C. Rigidity and akinesia
Rationale: Amantadine is an antiparkinson agent that potentiates the action of dopamine in the central nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Leukopenia, urinary retention, and hypotension are all adverse effects of the medication.
Test-Taking Strategy: Note the key words therapeutic effect. Begin to answer this question by recalling that this medication is used to treat Parkinson’s disease. This would lead you to choose option 3 as the expected effects of the medication. Also, knowledge of the medication reinforces that the other options are incorrect, because they are all adverse effects of the medication. Review this medication if you had difficulty with this question.
Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Evaluation
Content Area: Pharmacology
Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 168.
2. A client is receiving anticonvulsant therapy with phenytoin (Dilantin). The nurse plans to monitor the results of which laboratory test closely?
A. Complete blood count
B. Serum sodium level
C. Serum potassium level
D. Blood urea nitrogen level
Answer: A. Complete blood count
Rationale: The nurse monitors the client’s complete blood count because hematological side effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other values that warrant monitoring include serum calcium levels, and the results of urinalysis, hepatic function, and thyroid function tests.
Test-Taking Strategy: Focus on the name of the medication. Recalling that phenytoin causes hematological side effects will direct you to option A. If this question was difficult, review this medication.
Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Pharmacology
Reference: Skidmore-Roth, L. (2005). Mosby’s drug guide for nurses (6th ed.). St. Louis: Mosby, p. 691.
3. A client has been prescribed cyclobenzaprine (Flexeril) in the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse would withhold the medication and question the order if the client had concurrent orders to take:
A. Furosemide (Lasix)
B. Valproic acid (Depakene)
C. Ibuprofen (Motrin)
D. Tranylcypromine (Parnate)
Answer: D. Tranylcypromine (Parnate)
Rationale: The client should not receive cyclobenzaprine if the client has taken monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate) or phenelzine (Nardil) within the last 14 days. Otherwise, the client could experience hyperpyretic crisis, convulsions, or death.
Test-Taking Strategy: Note the key words withhold the medication and question the order. These words indicate a false response question and that you need to select the medication that is contraindicated with the use of cyclobenzaprine. Remember, cyclobenzaprine may not be taken when MAOIs have been administered within the last 14 days. If you had difficulty with this question, review this medication.
Level of Cognitive Ability: Analysis
Client Needs: Safe, Effective Care Environment
Integrated Process: Nursing Process/Implementation
Content Area: Pharmacology
Reference: Skidmore-Roth, L. (2005). Mosby’s drug guide for nurses (6th ed.). St. Louis: Mosby, p. 224.
4. A nurse is discussing with clients primary prevention measures regarding osteoporosis. The nurse plans to tell the clients that which of the following is a primary prevention measure?
A. Selecting shoes that have firm, nonskid soles
B. Installing telephones in most rooms of the house
C. Applying nonskid strips on areas that get wet
D. Maintaining body weight at or slightly above minimum recommended levels
Answer: D. Maintaining body weight at or slightly above minimum recommended levels
Rationale: Maintaining body weight at or slightly above minimum recommended levels is a primary prevention measure (thin, lean body build is a risk factor). Additional primary prevention measures include achieving optimal calcium intake, performing regular exercise, avoiding smoking and alcohol consumption, avoiding a high-sodium and high-protein diet, and consuming adequate amounts of vitamin D. Options 1, 2, and 3 include secondary preventive measures.
Test-Taking Strategy: Note the key word primary. Use knowledge regarding the differences between primary and secondary prevention measures to direct you to option D. Remember, primary prevention measures prevent the condition from occurring. Review the measures that will prevent osteoporosis if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Content Area: Adult Health/Musculoskeletal
Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 123.
5. A nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?
A. Uric acid level of 8.0 mg/dl
B. Calcium level of 9.0 mg/dl
C. Phosphorus level of 3.0 mg/dl
D. Uric acid level of 5.0 mg/dl
Answer: A. Uric acid level of 8.0 mg/dl
Rationale: In addition to the presence of clinical manifestations, gout is diagnosed by the presence of persistent hyperuricemia greater than 7.0 mg/dl. Options 2, 3, and 4 all indicate normal laboratory values. Additionally, the presence of uric acid in an aspirated sample of synovial fluid confirms the diagnosis.
Test-Taking Strategy: Focus on the client’s diagnosis and recall the pathophysiology associated with gout to direct you to option A. Also note that options 2, 3, and 4 identify normal laboratory values, whereas option 1 indicates an elevated value. Learn this normal laboratory value if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Adult Health/Musculoskeletal
Reference: Linton, A., & Maebius, N. (2003) Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 814.
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