NCLEX PN ARCHER REVIEW |!| |!| |!| |!|
(Newest Exam with precise |!| |!| |!| |!|
solutions & rationales) |!| |!|
The nurse is caring for a client exhibiting signs of poor muscle
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
coordination, stooped posture, and slow movements. Which |!| |!| |!| |!| |!| |!| |!|
medication is most likely to cause these symptoms? |!| |!| |!| |!| |!| |!| |!|
Haloperidol
Rationale:
Haloperidol is a typical antipsychotic that may adversely cause|!| |!| |!| |!| |!| |!| |!| |!| |!|
extrapyramidal side effects (EPS). These effects include akathisia, dystonia, |!| |!| |!| |!| |!| |!| |!| |!|
pseudo-parkinsonism, and/or tardive dyskinesia. Tardive dyskinesia is an
|!| |!| |!| |!| |!| |!| |!| |!| |!|
adverse effect that occurs with antipsychotics and has an onset of months
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
to years while on the medication.
|!| |!| |!| |!| |!|
While reviewing the morning labs of your client, you see the
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
following results from their thyroid panel. What diagnosis does
|!| |!| |!| |!| |!| |!| |!| |!| |!|
the nurse suspect?
|!| |!|
TSH: 7 mU/L |!| |!|
T4: 1.0 mcg/dL
|!| |!|
T3: 2.0 ng/dL
|!| |!|
Hypothyroidism
Rationale:
Hypothyroidism would be manifested with an increased thyroid-stimulating |!| |!| |!| |!| |!| |!| |!| |!|
hormone level and decreased T4 and T3, as shown in these labs. Because
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
of the increased TSH level, the thyroid gland is tricked into thinking that
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
there is enough thyroid hormone already in the body and does not secrete
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
more. The decreased T3 and T4 levels cause hypothyroidism symptoms,
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
such as weight gain and fatigue.
|!| |!| |!| |!| |!|
,The nurse reinforces teaching to a client with hypertension about
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the newly prescribed furosemide. Which of the following should
|!| |!| |!| |!| |!| |!| |!| |!| |!|
the nurse include in the teaching?
|!| |!| |!| |!| |!|
Take this medication in the early part of the day
|!| |!| |!| |!| |!| |!| |!| |!| |!|
Rationale:
Furosemide is a loop diuretic and may be indicated for conditions such as |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
heart failure or hypertension. The client should be instructed to take this
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
medication in the earlier part of the day to avoid nocturia. |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
The nurse is assessing a 7-month-old infant. At this age, which of
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the following reflexes would the nurse expect to no longer be
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
present? |!|
Select all that apply. |!| |!| |!|
Rooting
Moro
Palmar
Tonic neck |!|
Rationale:
- The Rooting reflex should disappear by 3-4 months of age. It occurs
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
when the infants turn their face toward stimulation (such as stroking their
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
cheek) and make sucking (rooting) motions with the mouth. This reflex
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
helps to ensure successful feeding.
|!| |!| |!| |!|
- The Moro reflex should disappear by 5-6 months of age. This reflex is a
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
response to a sudden loss of support. When support is removed, the infant
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
spreads out the arms and cries.
|!| |!| |!| |!| |!| |!|
- The Palmar reflex should disappear by 2-3 months of age. When an
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
object is placed in an infant's hand, and the palm is stroked, the fingers
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
will close reflexively.
|!| |!|
- The tonic neck reflex disappears around 4 months of age. This reflex is
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
elicited by turning the infant's head to one side and is considered positive
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
if the infant extends the extremities on the side that the head is turned
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
toward, and flexes the extremities on the opposite side.
|!| |!| |!| |!| |!| |!| |!| |!|
,The nurse is caring for a client with diabetes mellitus. Which of
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the following laboratory data requires follow-up?
|!| |!| |!| |!| |!| |!|
Select all that apply. |!| |!| |!|
Hemoglobin A1C 8.5% [< 5.7%] |!| |!| |!| |!|
Creatinine 1.9 mg/dL [0.6-1.2 mg/dL] |!| |!| |!| |!|
BUN 25 mg/dL [10-20 mg/dL] |!| |!| |!| |!|
Proteinuria
Rationale:
The client's hemoglobin A1C is elevated as the therapeutic goal for a
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
client with diabetes is to attain less than 7%. This elevated level is causing
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the client to experience an insult to the kidneys, which is evident by the
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
increased BUN (normal 10-20 mg/dL) and creatinine (normal 0.6-1.2 |!| |!| |!| |!| |!| |!| |!| |!| |!|
mg/dL). Finally, proteinuria is further evidence that this client is
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
experiencing diabetic nephropathy. |!| |!|
The nurse is caring for the following assigned clients. Which client
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
should the nurse follow up with first?
|!| |!| |!| |!| |!| |!| |!|
A client requesting diphenhydramine after starting an intravenous
|!| |!| |!| |!| |!| |!| |!| |!|
antibiotic.
Rationale:
A client requesting diphenhydramine following the initiation of an antibiotic
|!| |!| |!| |!| |!| |!| |!| |!| |!|
requires immediate follow-up because the client could be experiencing an
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
allergic reaction ranging from mild to severe. Thus, the nurse should
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
quickly follow-up with this client. |!| |!| |!| |!|
The nurse is assessing a 6-year-old client with asthma. Which of
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the following findings is of highest concern?
|!| |!| |!| |!| |!| |!|
Silent chest |!|
Rationale:
Silent chest is the assessment finding of most concern. This refers to the
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
inability to auscultate any lung sounds. There is complete obstruction of
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the client's airway, and therefore the inability to move air. When complete
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
obstruction occurs, this is a medical emergency. This assessment finding is |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
of most concern because the client has lost their airway.
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
, The nurse is caring for a client with newly prescribed zolpidem.
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
The nurse understands that this medication is indicated for which
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
condition?
Insomnia
Rationale:
Zolpidem is a non-benzodiazepine indicated in the treatment of insomnia.
|!| |!| |!| |!| |!| |!| |!| |!| |!|
*NGN* The nurse is caring for a 47-year-old male in the outpatient
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
clinic
|!|
Orders
Discharge home |!|
Schedule a follow-up appointment in four weeks |!| |!| |!| |!| |!| |!|
Sertraline 50 mg PO Daily |!| |!| |!| |!|
Clonidine 0.1 mg PO Daily |!| |!| |!| |!|
Zolpidem 5 mg PO, PRN insomnia |!| |!| |!| |!| |!|
The nurse reviews the orders and formulates a teaching plan for
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the newly prescribed medications
|!| |!| |!|
For each medication, select the appropriate option for drug
|!| |!| |!| |!| |!| |!| |!| |!| |!|
classification and client teaching that should be reinforced |!| |!| |!| |!| |!| |!| |!|
Clonidine - alpha2-adrenergic agonist |!| |!| |!|
This medication may cause you to become dizzy or tired.
|!| |!| |!| |!| |!| |!| |!| |!| |!|
Sertraline - selective serotonin reuptake inhibitor |!| |!| |!| |!| |!|
Diarrhea is a common side effect of this medication.
|!| |!| |!| |!| |!| |!| |!| |!|
Zolpidem - Hypnotic |!| |!|
Do not take this medication with alcohol
|!| |!| |!| |!| |!| |!|
Rationale:
- Clonidine is indicated in the treatment of hypertension. The medication
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
may be administered as a pill or transdermal patch for seven days. It
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
should not be abruptly discontinued because of the risk of rebound
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
hypertension due to a catecholamine surge. Clonidine has a sedative |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
(Newest Exam with precise |!| |!| |!| |!|
solutions & rationales) |!| |!|
The nurse is caring for a client exhibiting signs of poor muscle
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
coordination, stooped posture, and slow movements. Which |!| |!| |!| |!| |!| |!| |!|
medication is most likely to cause these symptoms? |!| |!| |!| |!| |!| |!| |!|
Haloperidol
Rationale:
Haloperidol is a typical antipsychotic that may adversely cause|!| |!| |!| |!| |!| |!| |!| |!| |!|
extrapyramidal side effects (EPS). These effects include akathisia, dystonia, |!| |!| |!| |!| |!| |!| |!| |!|
pseudo-parkinsonism, and/or tardive dyskinesia. Tardive dyskinesia is an
|!| |!| |!| |!| |!| |!| |!| |!| |!|
adverse effect that occurs with antipsychotics and has an onset of months
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
to years while on the medication.
|!| |!| |!| |!| |!|
While reviewing the morning labs of your client, you see the
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
following results from their thyroid panel. What diagnosis does
|!| |!| |!| |!| |!| |!| |!| |!| |!|
the nurse suspect?
|!| |!|
TSH: 7 mU/L |!| |!|
T4: 1.0 mcg/dL
|!| |!|
T3: 2.0 ng/dL
|!| |!|
Hypothyroidism
Rationale:
Hypothyroidism would be manifested with an increased thyroid-stimulating |!| |!| |!| |!| |!| |!| |!| |!|
hormone level and decreased T4 and T3, as shown in these labs. Because
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
of the increased TSH level, the thyroid gland is tricked into thinking that
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
there is enough thyroid hormone already in the body and does not secrete
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
more. The decreased T3 and T4 levels cause hypothyroidism symptoms,
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
such as weight gain and fatigue.
|!| |!| |!| |!| |!|
,The nurse reinforces teaching to a client with hypertension about
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the newly prescribed furosemide. Which of the following should
|!| |!| |!| |!| |!| |!| |!| |!| |!|
the nurse include in the teaching?
|!| |!| |!| |!| |!|
Take this medication in the early part of the day
|!| |!| |!| |!| |!| |!| |!| |!| |!|
Rationale:
Furosemide is a loop diuretic and may be indicated for conditions such as |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
heart failure or hypertension. The client should be instructed to take this
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
medication in the earlier part of the day to avoid nocturia. |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
The nurse is assessing a 7-month-old infant. At this age, which of
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the following reflexes would the nurse expect to no longer be
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
present? |!|
Select all that apply. |!| |!| |!|
Rooting
Moro
Palmar
Tonic neck |!|
Rationale:
- The Rooting reflex should disappear by 3-4 months of age. It occurs
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
when the infants turn their face toward stimulation (such as stroking their
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
cheek) and make sucking (rooting) motions with the mouth. This reflex
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
helps to ensure successful feeding.
|!| |!| |!| |!|
- The Moro reflex should disappear by 5-6 months of age. This reflex is a
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
response to a sudden loss of support. When support is removed, the infant
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
spreads out the arms and cries.
|!| |!| |!| |!| |!| |!|
- The Palmar reflex should disappear by 2-3 months of age. When an
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
object is placed in an infant's hand, and the palm is stroked, the fingers
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
will close reflexively.
|!| |!|
- The tonic neck reflex disappears around 4 months of age. This reflex is
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
elicited by turning the infant's head to one side and is considered positive
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
if the infant extends the extremities on the side that the head is turned
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
toward, and flexes the extremities on the opposite side.
|!| |!| |!| |!| |!| |!| |!| |!|
,The nurse is caring for a client with diabetes mellitus. Which of
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the following laboratory data requires follow-up?
|!| |!| |!| |!| |!| |!|
Select all that apply. |!| |!| |!|
Hemoglobin A1C 8.5% [< 5.7%] |!| |!| |!| |!|
Creatinine 1.9 mg/dL [0.6-1.2 mg/dL] |!| |!| |!| |!|
BUN 25 mg/dL [10-20 mg/dL] |!| |!| |!| |!|
Proteinuria
Rationale:
The client's hemoglobin A1C is elevated as the therapeutic goal for a
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
client with diabetes is to attain less than 7%. This elevated level is causing
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the client to experience an insult to the kidneys, which is evident by the
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
increased BUN (normal 10-20 mg/dL) and creatinine (normal 0.6-1.2 |!| |!| |!| |!| |!| |!| |!| |!| |!|
mg/dL). Finally, proteinuria is further evidence that this client is
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
experiencing diabetic nephropathy. |!| |!|
The nurse is caring for the following assigned clients. Which client
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
should the nurse follow up with first?
|!| |!| |!| |!| |!| |!| |!|
A client requesting diphenhydramine after starting an intravenous
|!| |!| |!| |!| |!| |!| |!| |!|
antibiotic.
Rationale:
A client requesting diphenhydramine following the initiation of an antibiotic
|!| |!| |!| |!| |!| |!| |!| |!| |!|
requires immediate follow-up because the client could be experiencing an
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
allergic reaction ranging from mild to severe. Thus, the nurse should
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
quickly follow-up with this client. |!| |!| |!| |!|
The nurse is assessing a 6-year-old client with asthma. Which of
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the following findings is of highest concern?
|!| |!| |!| |!| |!| |!|
Silent chest |!|
Rationale:
Silent chest is the assessment finding of most concern. This refers to the
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
inability to auscultate any lung sounds. There is complete obstruction of
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the client's airway, and therefore the inability to move air. When complete
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
obstruction occurs, this is a medical emergency. This assessment finding is |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
of most concern because the client has lost their airway.
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
, The nurse is caring for a client with newly prescribed zolpidem.
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
The nurse understands that this medication is indicated for which
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
condition?
Insomnia
Rationale:
Zolpidem is a non-benzodiazepine indicated in the treatment of insomnia.
|!| |!| |!| |!| |!| |!| |!| |!| |!|
*NGN* The nurse is caring for a 47-year-old male in the outpatient
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
clinic
|!|
Orders
Discharge home |!|
Schedule a follow-up appointment in four weeks |!| |!| |!| |!| |!| |!|
Sertraline 50 mg PO Daily |!| |!| |!| |!|
Clonidine 0.1 mg PO Daily |!| |!| |!| |!|
Zolpidem 5 mg PO, PRN insomnia |!| |!| |!| |!| |!|
The nurse reviews the orders and formulates a teaching plan for
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
the newly prescribed medications
|!| |!| |!|
For each medication, select the appropriate option for drug
|!| |!| |!| |!| |!| |!| |!| |!| |!|
classification and client teaching that should be reinforced |!| |!| |!| |!| |!| |!| |!|
Clonidine - alpha2-adrenergic agonist |!| |!| |!|
This medication may cause you to become dizzy or tired.
|!| |!| |!| |!| |!| |!| |!| |!| |!|
Sertraline - selective serotonin reuptake inhibitor |!| |!| |!| |!| |!|
Diarrhea is a common side effect of this medication.
|!| |!| |!| |!| |!| |!| |!| |!|
Zolpidem - Hypnotic |!| |!|
Do not take this medication with alcohol
|!| |!| |!| |!| |!| |!|
Rationale:
- Clonidine is indicated in the treatment of hypertension. The medication
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
may be administered as a pill or transdermal patch for seven days. It
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
should not be abruptly discontinued because of the risk of rebound
|!| |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
hypertension due to a catecholamine surge. Clonidine has a sedative |!| |!| |!| |!| |!| |!| |!| |!| |!| |!|
