NCLEX Practice Questions Free 2019 / 2020 54th Edition

NCLEX Practice Questions Free 2019 / 2020 54th Edition

1. Prednisone (Deltasone) is prescribed for a client with diabetes mellitus who is taking NPH insulin daily. Which of the following prescriptions would the nurse anticipate during therapy with the prednisone?

A. A decreased amount of daily NPH insulin
B. An increased amount of daily NPH insulin
C. An additional dose of prednisone daily
D. Addition of an oral hypoglycemic medication daily

Answer: B. An increased amount of daily NPH insulin

Rationale: Glucocorticoids can elevate blood levels of glucose. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Options 1, 3, and 4 are incorrect.

Test-Taking Strategy: Use the process of elimination. Recalling that glucocorticoids can increase the level of blood glucose will assist in eliminating options 1 and C. Noting that the client is taking insulin will assist in directing you to option B. Review the side effects of prednisone if you had difficulty with this question.

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. 714.

2. Cortisone (Cortone) is prescribed for a client with adrenal insufficiency, and the nurse reinforces instructions to the client regarding the medication. Which statement by the client would indicate a need for further instruction?

A. “I will eat a good breakfast every day.”
B. “I will avoid people with colds.”
C. “I will limit my sodium intake.”
D. “I will stop the medication when I feel better.”

Answer: D. “I will stop the medication when I feel better.”

Rationale: Glucocorticoids should not be abruptly discontinued to prevent acute adrenal insufficiency. They can cause sodium and water retention and the loss of potassium, and clients should be instructed to limit sodium intake and consume potassium-rich foods. These medications can increase the risk of infection, and the client should avoid contact with persons who are ill.

Test-Taking Strategy: Note the key words need for further instruction. These words indicate a false response question and that you need to select the incorrect client statement. Use knowledge regarding the administration of glucocorticoids and the general guidelines related to medication administration. You should easily be able to eliminate options 1, 2, and 3 remembering that the client should not stop these medications or, in fact, any medication without physician approval. Review client teaching points related to this medication if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Content Area: Pharmacology
Reference: Skidmore-Roth, L. (2005). Mosby’s drug guide for nurses (6th ed.). St. Louis: Mosby, p. 223.

3. Etidronate (Didronel), an antihypercalcemic medication, is prescribed for a client. The nurse instructs the client to take the medication:

A. Two hours before meals
B. With meals
C. With milk
D. With an antacid

Answer: A. Two hours before meals


Rationale: Etidronate should be taken on an empty stomach 2 hours before meals. It should not be taken within 2 hours of vitamins, mineral supplements, antacids, or medications high in calcium, magnesium, iron, or albumin.

Test-Taking Strategy: Use the process of elimination. Eliminate options 2, 3, and 4 because they are similar. Note that each of these options suggests administering the medication with another substance. Option 1 is the only option that reflects administering the medication on an empty stomach. Review concepts related to the administration of this medication if you had difficulty with this question.

Level of Cognitive Ability: Application
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Content Area: Pharmacology
Reference: Skidmore-Roth, L. (2005). Mosby’s drug guide for nurses (6th ed.). St. Louis: Mosby, p. 338.

4. Fludrocortisone (Florinef) is prescribed for a client with Addison’s disease. The nurse prepares to administer the medication knowing that the primary action of this medication is to:

A. Promote the reabsorption of sodium and chloride ions in the distal tubules of the kidney
B. Promote the retention of potassium in the distal tubules of the kidney
C. Promote the retention of hydrogen ions in the distal tubules of the kidney
D. Promote the excretion of water in the distal tubules of the kidney

Answer: A. Promote the reabsorption of sodium and chloride ions in the distal tubules of the kidney

Rationale: Fludrocortisone has mineralocorticoid activity and also has a glucocorticoid effect. It acts primarily on the kidneys’ distal tubules, enhancing the reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. It promotes water retention.

Test-Taking Strategy: Knowledge regarding the action of fludrocortisone is required to answer the question. If you are unfamiliar with this medication, try to recall the pathophysiology associated with Addison’s disease to assist in answering the question. Review this medication’s action if you are unfamiliar with it.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Pharmacology
Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 444.

Source : NCLEX example quiz and answer

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