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NCLEX-PN Exam Questions - Part 111
1. The factor that most determines drug distribution is:
A) vascular perfusion of the tissue or organ.
B) salt form.
C) drug interactions.
D) steady state.
2. Metformin (Glucophage) is administered to clients with type II diabetes mellitus. Metformin is an example of:
A) an antihyperglycemic agent.
B) a hypoglycemic agent.
C) an insulin analogue.
D) a pancreatic alpha cell stimulant.
3. A client was involved in a motor vehicle accident in which the seat belt was not worn. The client is exhibiting crepitus, decreased breath sounds on the left, complains of shortness of breath, and has a respiratory rate of 34/min. Which of the following assessment findings should concern the nurse the most?
A) temperature of 102° F and a productive cough
B) arterial blood gases (ABGs) with a PaO2 of 92 and PaCO2 of 40 mmHg
C) trachea deviating to the right
D) barrel-chested appearance
4. A nurse is teaching a client newly diagnosed with Emphysema about the disease process. Which of the following statements best explains the problems associated with emphysema and could be adapted for use in the nurses discussion with the client?
A) Hyperactivity of the medium-sized bronchi caused by an inflammatory response leads to wheezing and tightness in the chest.
B) Larger than normal air spaces and loss of elastic recoil cause air to be trapped in the lung and collapse airways.
C) Vasodilation, congestion, and mucosal edema cause a chronic cough and sputum production.
D) Chloride is not being transported properly, producing excess absorption of water and sodium, and thick viscous mucus.
5. A client admitted to the medical nursing unit has classic symptoms of tuberculosis (TB) and tests positive on the purified protein derivative (PPD) skin test. Several months later, the nurse who cared for the client also tests positive on an annual TB skin test for work. The most likely course of treatment if the chest X-ray (CXR) is negative is to:
A) repeat a TB skin test in six months.
B) treat the nurse with an anti-infective agent for six months.
C) monitor for signs and symptoms within the next year.
D) follow up in one year at the next annual physical with CXR only.
A) vascular perfusion of the tissue or organ.
B) salt form.
C) drug interactions.
D) steady state.
2. Metformin (Glucophage) is administered to clients with type II diabetes mellitus. Metformin is an example of:
A) an antihyperglycemic agent.
B) a hypoglycemic agent.
C) an insulin analogue.
D) a pancreatic alpha cell stimulant.
3. A client was involved in a motor vehicle accident in which the seat belt was not worn. The client is exhibiting crepitus, decreased breath sounds on the left, complains of shortness of breath, and has a respiratory rate of 34/min. Which of the following assessment findings should concern the nurse the most?
A) temperature of 102° F and a productive cough
B) arterial blood gases (ABGs) with a PaO2 of 92 and PaCO2 of 40 mmHg
C) trachea deviating to the right
D) barrel-chested appearance
4. A nurse is teaching a client newly diagnosed with Emphysema about the disease process. Which of the following statements best explains the problems associated with emphysema and could be adapted for use in the nurses discussion with the client?
A) Hyperactivity of the medium-sized bronchi caused by an inflammatory response leads to wheezing and tightness in the chest.
B) Larger than normal air spaces and loss of elastic recoil cause air to be trapped in the lung and collapse airways.
C) Vasodilation, congestion, and mucosal edema cause a chronic cough and sputum production.
D) Chloride is not being transported properly, producing excess absorption of water and sodium, and thick viscous mucus.
5. A client admitted to the medical nursing unit has classic symptoms of tuberculosis (TB) and tests positive on the purified protein derivative (PPD) skin test. Several months later, the nurse who cared for the client also tests positive on an annual TB skin test for work. The most likely course of treatment if the chest X-ray (CXR) is negative is to:
A) repeat a TB skin test in six months.
B) treat the nurse with an anti-infective agent for six months.
C) monitor for signs and symptoms within the next year.
D) follow up in one year at the next annual physical with CXR only.
1. Right Answer: A
Explanation: Drugs are distributed via the circulatory system. Adequate perfusion is necessary for distribution of a drug.Choices 2, 3, and 4 are not as dependent on adequate perfusion. Pharmacological Therapies
2. Right Answer: A
Explanation: This antihyperglycemic agent prevents hyperglycemia by reducing hepatic glucose output and decreasing glucose absorption from the gut. A hypoglycemic drug stimulates insulin production. Metformin is not a type of insulin. Metformin is not a stimulant of any pancreatic cell. Pharmacological Therapies
3. Right Answer: C
Explanation: A mediastinal shift is indicative of a tension pneumothorax along with the other symptoms in the question.Because the individual was involved in an MVA, assessment is targeted at acute traumatic injuries to the lungs, heart, or chest wall rather than other conditions indicated in the other choices. Choice 1 is common with pneumonia. Values in Choice 2 are not alarming. Choice 4 is typical of someone with chronic obstructive pulmonary disease (COPD). A tension pneumothorax is a dangerous complication and a medical emergency where entering air cannot escape by the same route and pressure within the pleural cavity increases, resulting in complete collapse of the lung. A mediastinal shift to the unaffected side and a downward displacement of the diaphragm can be observed.Physiological Adaptation
4. Right Answer: B
Explanation: Larger-than-normal air spaces and loss of elastic recoil cause air to be trapped in the lung and collapse airways. Emphysema is a breakdown of the elastin and fiber network of the alveoli where the alveoli enlarge or the walls are destroyed. This alveolar destruction leads to the formation of larger-than-normal air spaces.Emphysema is one of a group of pulmonary diseases of a chronic nature characterized by increased resistance to airflow; the entity is part of chronic obstructive pulmonary disease (COPD). Physiological Adaptation
5. Right Answer: B
Explanation: Exposure with a positive TB skin test usually requires six months of prophylactic treatment unless contraindicated. The TB skin test should not be repeated; the results will always be positive. A CXR is usually not required annually in the event that the skin test was positive. TB is a type of pneumonia caused by the acid- fast bacillus, mycobacterium tuberculosis, and is contracted by airborne droplets that enter the lungs and multiply in the pulmonary alveoli. Nursing Assessment:(1) Assessment includes symptom analysis of type and progression of symptoms; color, consistency, and amount of sputum; knowledge of the disease; weight pattern; vital signs; description of any pain; palpable lymph nodes; breath sounds; and activity tolerance. (2) Diagnostic tests:a) CXR (shows dense lesions in the upper lobes, enlarged lymph nodes, and formation of large cavities); b) CBC (presence of leukocytosis); c) Fiberoptic bronchoscopy and bronchial washing (for obtaining culture specimens); d) Tuberculin skin test (positive at 5 to 9 mm for clients with abnormal CXR or HIV; positive at 10 to 15 mm for clients with high-risk factors such as intravenous [IV] drug use; residence in a long-term facility, high-incidence country; positive at 15 mm for all other people); e) Three early-morning sputum collections for acid-fast staining, culture and sensitivity positive for M. tuberculosis. Results can take up to 10 days.Physiological Adaptation
Explanation: Drugs are distributed via the circulatory system. Adequate perfusion is necessary for distribution of a drug.Choices 2, 3, and 4 are not as dependent on adequate perfusion. Pharmacological Therapies
2. Right Answer: A
Explanation: This antihyperglycemic agent prevents hyperglycemia by reducing hepatic glucose output and decreasing glucose absorption from the gut. A hypoglycemic drug stimulates insulin production. Metformin is not a type of insulin. Metformin is not a stimulant of any pancreatic cell. Pharmacological Therapies
3. Right Answer: C
Explanation: A mediastinal shift is indicative of a tension pneumothorax along with the other symptoms in the question.Because the individual was involved in an MVA, assessment is targeted at acute traumatic injuries to the lungs, heart, or chest wall rather than other conditions indicated in the other choices. Choice 1 is common with pneumonia. Values in Choice 2 are not alarming. Choice 4 is typical of someone with chronic obstructive pulmonary disease (COPD). A tension pneumothorax is a dangerous complication and a medical emergency where entering air cannot escape by the same route and pressure within the pleural cavity increases, resulting in complete collapse of the lung. A mediastinal shift to the unaffected side and a downward displacement of the diaphragm can be observed.Physiological Adaptation
4. Right Answer: B
Explanation: Larger-than-normal air spaces and loss of elastic recoil cause air to be trapped in the lung and collapse airways. Emphysema is a breakdown of the elastin and fiber network of the alveoli where the alveoli enlarge or the walls are destroyed. This alveolar destruction leads to the formation of larger-than-normal air spaces.Emphysema is one of a group of pulmonary diseases of a chronic nature characterized by increased resistance to airflow; the entity is part of chronic obstructive pulmonary disease (COPD). Physiological Adaptation
5. Right Answer: B
Explanation: Exposure with a positive TB skin test usually requires six months of prophylactic treatment unless contraindicated. The TB skin test should not be repeated; the results will always be positive. A CXR is usually not required annually in the event that the skin test was positive. TB is a type of pneumonia caused by the acid- fast bacillus, mycobacterium tuberculosis, and is contracted by airborne droplets that enter the lungs and multiply in the pulmonary alveoli. Nursing Assessment:(1) Assessment includes symptom analysis of type and progression of symptoms; color, consistency, and amount of sputum; knowledge of the disease; weight pattern; vital signs; description of any pain; palpable lymph nodes; breath sounds; and activity tolerance. (2) Diagnostic tests:a) CXR (shows dense lesions in the upper lobes, enlarged lymph nodes, and formation of large cavities); b) CBC (presence of leukocytosis); c) Fiberoptic bronchoscopy and bronchial washing (for obtaining culture specimens); d) Tuberculin skin test (positive at 5 to 9 mm for clients with abnormal CXR or HIV; positive at 10 to 15 mm for clients with high-risk factors such as intravenous [IV] drug use; residence in a long-term facility, high-incidence country; positive at 15 mm for all other people); e) Three early-morning sputum collections for acid-fast staining, culture and sensitivity positive for M. tuberculosis. Results can take up to 10 days.Physiological Adaptation
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