NCLEX Practice Set 5

A client presents to the emergency room, complaining of significant abdominal pain and heavy vaginal bleeding. She reports she received a positive urine pregnancy test a few weeks ago. Upon further assessment, the client is diagnosed with an ectopic pregnancy.

>Which of the following are priority nursing interventions as the patient is prepped for emergent surgery?

A nurse volunteers to help with an immunization clinic at the local hospital.

>Which of the following is considered inappropriate injection technique?

The nurse is educating a newly diagnosed type 2 diabetic about foot care.

>Which of the following statements indicates the need for further teaching?

The nurse is reviewing the health history of a woman who wants to use a combined hormonal contraceptive for birth control.

>Which of the following would be considered a contraindication to this form of birth control?

A healthcare facility is undergoing a bioterrorism drill, and a client is admitted with the following symptoms: high fever, red spots and sores on tongue and mouth, and body aches.

>Which bioterrorism agent is most likely?

A client is admitted with an exacerbation of congestive heart failure. The nurse walks into the room to give the client Lasix per physician orders, but the client refuses. He states “I don’t want it. It makes me pee too much.”

>Which of the following actions is appropriate in this situation?

A client has been intubated after presenting with respiratory distress. The oncoming nurse for the night shift hears the high-pressure alarm go off on the ventilator and enters the room to investigate.

>Which of the following requires immediate action by the nurse?

A graduate nurse has a client that requires insulin at breakfast. He receives both NPH and regular insulin. The order reads “Give 10 units of NPH insulin and 6 units of Regular insulin.” The graduate nurse has a second nurse present with her while she is drawing up the insulin.

>Which is the correct order of steps for this procedure?

A. Inject 10 units of air into the vial of NPH.
B. Draw up 6 units of Regular insulin into the syringe.
C. Draw up 10 units of NPH insulin into the syringe.
D. Inject 6 units of air into the vial of Regular insulin.

A nurse has a physician’s order to perform an ear irrigation secondary to cerumen impaction in a 60-year-old male. The nurse gathers her supplies and warms the irrigating solution.

>Which of the following is an incorrect step in the process of irrigating the ear?

The nurse is reviewing charts on several GYN clients, concentrating on cervical cancer surveillance.

>Which of the following is an example of inappropriate cervical cancer screening, according to current recommendations by the United States Preventive Services Task Force (USPSTF)?