NCLEX PN Examination 66th Edition (Update September 2019)

NCLEX PN Examination 66th Edition (Update September 2019)

1. A client with human immunodeficiency virus (HIV) who has contracted tuberculosis (TB) asks the nurse how long the medication therapy lasts. The nurse responds that the duration of therapy would most likely be for at least:

A. Six total months and at least 1 month after cultures convert to negative
B. Six total months and at least 3 months after cultures convert to negative
C. Nine total months and at least 3 months after cultures convert to negative
D. Nine total months and at least 6 months after cultures convert to negative

Answer: D. Nine total months and at least 6 months after cultures convert to negative

Rationale: The client with tuberculosis who is coinfected with HIV requires that antituberculosis therapy last longer than usual. The prescription is usually for a total of 9 months and at least 6 months after sputum cultures convert to negative.

Test-Taking Strategy: Use the process of elimination. Knowing that the client with HIV requires longer therapy helps you to eliminate options 1 and 2 first. To select between the last two options, it is necessary to recall that sputum culture must be negative for 6 months before terminating medication therapy because of the immunosuppressed status of the client. Review the guidelines related to medication therapy in the client with TB if you had difficulty with this question.

Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Adult Health/Immune
Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, p. 375.

2. Morphine sulfate is being administered to a client with cancer. The nurse is monitoring the client for signs of overdose related to this medication therapy. Which of the following findings if noted in the client would require notification of the registered nurse?

A. Blood pressure 110/70 mm Hg
B. Apical rate of 72 beats/min
C. Temperature of 98.6° F
D. Respirations of 10 breaths/min

Answer: D. Respirations of 10 breaths/min

Rationale: Before an opioid is administered, respiratory rate, blood pressure, and pulse rate should be determined. The registered nurse is notified immediately if the respiratory rate is at or below 12 breaths per minute, if the blood pressure is significantly below the pretreatment value, or if the pulse rate is significantly above or below the pretreatment value. The registered nurse would then contact the physician.

Test-Taking Strategy: Knowledge regarding normal vital sign measurements will assist in directing you to the correct option. Additionally, knowing that morphine sulfate primarily affects the respiratory rate will assist in directing you to option D. Review the adverse effects of 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: Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B. Saunders, p. 250.

3. A nurse is collecting data from a client who is experiencing the typical clinical manifestations of tuberculosis (TB). The nurse would expect the client to report having symptoms of fatigue and cough that have been present for:

A. A day or two
B. Almost a week
C. One to 2 weeks
D. Several weeks to months

Answer: D. Several weeks to months

Rationale: The client with tuberculosis may report symptoms that have been present for weeks or even months. The symptoms may include fatigue, lethargy, chest pain, anorexia and weight loss, night sweats, low grade fever, and cough with mucoid or blood-streaked sputum. It may be the production of blood-tinged sputum that finally forces some clients to seek care.

Test-Taking Strategy: To answer this question, it is necessary to be familiar with the usual clinical manifestations of TB. Even without specific knowledge, you may be able to determine the correct answer by knowing that TB is an insidious health problem, which is hard to eradicate. It makes sense that if clients reported it early, it would not be the increasingly prominent health problem that it is. Review the clinical manifestations of TB 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/Respiratory
Reference: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 602.

4. A client who is human immunodeficiency virus (HIV) positive has had a Mantoux test. The results show a 7-mm area of induration. The nurse evaluates that this result is:

A. Negative
B. Borderline
C. Uncertain
D. Positive

Answer: D. Positive

Rationale: The client with HIV is considered to have positive results on Mantoux testing with an area of 5 mm of induration or greater. The client without HIV has positive test results with induration greater than 10 mm or 15 mm if the client is at low risk. The client with HIV is immunosuppressed, making a smaller area of induration a positive test result for this type of client. It is also possible for the client infected with HIV to have false-negative readings because of the immunosuppression factor.

Test-Taking Strategy: Use the process of elimination to answer the question. Begin by eliminating options 2 and 3 because they are similar. Remembering that the client with HIV is immunosuppressed will assist in directing you to option 4, the correct option. Review the procedures for interpreting the results of this test if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Evaluation
Content Area: Adult Health/Immune
Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, p. 374.

Source : NCLEX example quiz and answer

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