NCLEX RN 2021 Review Questions and answers, 100% proven pass rate.

NCLEX RN 2021 Review Questions and answers, 100% proven pass rate. Document Content and Description Below NCLEX RN 2021 Review Questions and answers, 100% proven pass rate. A client who has amyotrophic lateral sclerosis is having frequent episodes of dysphagia. Which of the following referrals is app ropriate for the nurse to make currently? 1. Physical Therapist 2. Speech Pathologist 3. Registered Dietitian 4. Occupational Therapist - 2. Speech Pathologist A client who has chronic progressive dementia exhibits symptoms of malnutrition. Which action is needed at this time? 1. Notify social services about concern for abuse. 2. Initiate a consult for physical therapy to visit daily. 3. Ask home care services to provide written instructions. 4. Arrange a meeting with the interprofessional team to coordinate care? - 4. Arrange a meeting with the interprofessional team to coordinate care? A nurse should recognize which of the following clients are likely to need rehabilitation services after hepatization? (SATA) 1. School-age child who is recovering from an appendectomy. 2. Client who had a cesarean delivery for a breech presentation. 3. An adult client who has left hemiplegia after a stroke. 4. An adult client who is recovering from Guillain-Barre syndrome. 5. An older adult client who had a left hip replacement. 6. An adolescent client who required hospitalization due to asthma. - 3. An adult client who has left hemiplegia after a stroke. 4. An adult client who is recovering from Guillain-Barre syndrome. 5. An older adult client who had a left hip replacement. A nurse is assigned to a group of clients. Which of the following has an increased risk of aspiration while eating? (SATA) 1. A client who has a new diagnosis of gastroesophageal reflux disease. 2. A client who has admitted with a diagnosis of cerebrovascular accident. 3. A client who is 4 hr. post-op and received general anesthesia. 4. A client who is 8 hr. following traumatic laryngeal nerve damage. 5. A client who continually experiences prolonged coughing episodes. - 2. A client who has admitted with a diagnosis of cerebrovascular accident. 3. A client who is 4 hr. post op and received general anesthesia. 4. A client who is 8 hr. following traumatic laryngeal nerve damage. 5. A client who continually experiences prolonged coughing episodes. A client is receiving packed RBCs and becomes tachypneic. The client's temperature changes from 36.8*C (98.4*F) to 38.4*C (101.2*F). Which of the nursing interventions should the nurse perform first. 1. Give 750 mg acetaminophen orally. 2. Collect blood and urine specimens for analysis. 3. Administer and IV infusion of 0.9% sodium chloride. 4. Stop the infusion and return the blood to the lab. - 4. Stop the infusion and return the blood to the lab. A nurse receives a request from four clients at the same time. Which of the following clients should the nurse address first? A client who 1. Needs to void 1 hr. after removal of an indwelling urinary catheter. 2. Reports restlessness and shortness of breath following surgery for a fractured femur. 3. Asks for a stool softener 2 days following surgery. 4. Demands to take prescribed insulin early the spouse is bringing dinner. - 2. Reports restlessness and shortness of breath following surgery for a fractured femur. After receiving the report, a nurse should plan to access the clients in which priority order? 1. A 9-month-old who is receiving hydration therapy with IV fluids infusion peripherally. 2. A 6-year-old who is receiving continuous chemotherapy via a central venous catheter. 3. A 14-year-old who is awaiting discharge instructions receiving prednisone therapy. 4. An 8-year-old who is 2 days postoperative with an indwelling urinary catheter. - 1st) 2. A 6-year-old who is receiving continuous chemotherapy via a central venous catheter. 2nd) 1. A 9-month-old who is receiving hydration therapy with IV fluids infusion peripherally. 3rd) 4. An 8-year-old who is 2 days postoperative with an indwelling urinary catheter. 4th) 3. A 14-year-old who is awaiting discharge instructions receiving prednisone therapy. A nurse received the report and should plan to see which of the following client first? 1. A client at 39 weeks of gestation who is having contractions over 5 min lasting45 to 60 seconds. 2. A client who is pregnant and has a blood glucose level of 150mg/dl. 3. A client at 33 weeks of gestation who is receiving magnesium sulfate IV. 4. A client 1 day postpartum who has changed perineal pads twice in the last 7 hr. - 3. A client at 33 weeks of gestation who is receiving magnesium sulfate IV. After receiving the report, which of the following clients should the nurse see first? 1. A client who was admitted with kidney stones and is crying with back pain. 2. A client who had chest discomfort prior to admission and is now requesting coffee. 3. A client who is scheduled for surgery and needs the linen changed. 4. A client who is to receive one unit of packed RBCs today and needs an IV restarted. - 1. A client who was admitted with kidney stones and is crying with back pain. The nurse should triage which of the following clients first? 1. Vomiting, photosensitivity, and stiff neck. 2. Elevated temperature, sore throat, and fatigue. 3. A guarded gait and a bruised, edematous ankle. 4. Cloudy urine with painful urination. - 1. Vomiting, photosensitivity, and stiff neck. 5 Rights of Delegation - Right Person Right Task Right Circumstance Right Direction/Communication Right Supervision/Evaluation Scope of Practice RN - LPN - UAP - - RN - Unstable clients, Assessments, Initiate Care Plans, Initial Teaching, Blood Productions, IV Fluids and IV Push Medications. LPN - Stable clients, Gather data, Contribute to Care Plan, Reinforce Teaching, Monitor IVFs and Blood Transfusions, Administer Piggybacks. UAP - Stable clients, Obtain Vital Signs, Gather specific date, Hygiene care, Bed making, Feeding, Positioning, Ambulation. A nurse is organizing care for four clients, which of the following tasks should the nurse instruct the UAP to perform? 1. Measure the urine output from a client who was recently admitted with dehydration. 2. Bathe and shampoo hair for a client who was just admitted after a motor vehicle crash. 3. Help a client who is requesting a bedpan after a lumbar puncture. 4. Decrease the oxygen on a nasal cannula for a client who is being discharged with COPD. - 1. Measure the urine output from a client who was recently admitted with dehydration. Which of the following tasks should a nurse assign to the experienced unlicensed assistive personnel (UAP)? (SATA) 1. Completing intake and output measurements. 2. Feeding a client who has early dementia. 3. Explaining oral hygiene to a client receiving chemotherapy. 4. Bathing a client two days after a cerebrovascular accident. 5. Ambulating a client who is one-day post-hysterectomy. 6. Assisting a client who has hypertension select low-sodium snacks. - 1. Completing intake and output measurements. 2. Feeding a client who has early dementia 4. Bathing a client two days after a cerebrovascular accident. 5. Ambulating a client who is one-day post-hysterectomy. A nurse is supervising care delegated to a UAP. The nurse should take corrective action if which of the following is observed? 1. Allowing a client to sit in a bedside chair while discarding bathwater. 2. Pulling the curtain partially around the bed while performing perineal care. 3. Raising the bed and lowing the side rail while repositioning a client. 4. Answering a call that rings the hospital telephone while the client is away. - 2. Pulling the curtain partially around the bed while performing perineal care. A nurse delegates hygiene care for a client hospitalized with COPD to unlicensed assistive personnel. Which of the following is the most appropriate instruction for the nurse to give? 1. Delay hygiene care until one hour after breakfast. 2. Allow the client to nap with the lead of the bed elevated. 3. Encourage the client to participate in hygiene care. 4. Teach the client to breathe slowly and deeply. - 1. Delay hygiene care until one hour after breakfast. An LPN reports the following data to the supervising RN regarding data collection for a client who has congestive heart failure: Pulse oximetry 85%, respirations 48/min and labored. What is the priority action at this time? 1. The LPN will administer IV Furosemide. 2. The respiratory therapist will be notified. 3. The client will be prepared for a chest x-ray. 4. The care of the client will be reassigned to an RN. - 4. The care of the client will be reassigned to an RN. A nurse from the adult medical unit is assigned to the pediatric unit. Which of the following would be an appropriate assignment? 1. A toddler admitted with epiglottitis. 2. A school-age child scheduled for excision of a Wilms tumor. 3. An infant who is recovering from repair of a cleft lip and palate. 4. A preschooler who had surgical fixation of a fractured humerus. - 4. A preschooler who had surgical fixation of a fractured humerus. A nurse coordinates care for a client who had a cerebrovascular accident. Which of the following tasks should be addressed by the Physical Therapist? (SATA) 1. Completing self-care. 2. Thickening clear liquids. 3. Using devices for walking. 4. Transferring from chair to bed. 5. Administering Albuterol treatment. - 3. Using devices for walking. 4. Transferring from chair to bed. A client is recovering from a cerebrovascular adducent and has orders to be transferred to a rehabilitation center. Which of the following date should the nurse include in the verbal report? (SATA) 1. The client has been married three times. 2. The client is moving all extremities well. 3. The client is being treated for hypertension. 4. The client has three children who visit daily. 5. The client has an unrepaired aortic aneurism. 6. The client initially received the wrong IV fluids. - 2. The client is moving all extremities well. 3. The client is being treated for hypertension. 4. The client has three children who visit daily. 5. The client has an unrepaired aortic aneurism. A nurse contract the provider and questions the prescription of enoxaparin for a client who is allergic to heparin. The provider directs the nurse to give the medication as prescribed. Which of the following should be the priority action by the nurse? 1. Submit an incident report to the nurse manager. 2. Decline to administer the medication. 3. Document datils of the conversation in the medical record. 4. Immediately report this situation to the charge nurse. - 2. Decline to administer the medication. A client was recently placed in seclusion after exhibiting behaviors of acute mania. What is the appropriate nursing action? 1. Review medical history for potential contraindications of seclusion. 2. Obtain a verbal prescription now and request a medical evaluation with 12 hr. 3. Maintain seclusion if the client continues to exhibit signs of delirium. 4. Administer propofol 80 mg IV and repeat as needed. - 1. Review medical history for potential contraindications of seclusion. A client who is admitted with an epidural hematoma attempts to leave the hospital without a discharge prescription from the provider. After notifying the provider. After notifying the provider, which action should the nurse take? 1. Explain risk to the client. 2. Notify the legal department. 3. Provider discharge instructions. 4. Administer prescribed medications. - 1. Explain risk to the client. A nurse prepares to ask a client to sign a consent for an elective surgical procedure and notes the client received midazolam hydrochloride 1 hr. ago. Which of the following actions should the nurse take? 1. Ask a family member to sign the consent. 2. Obtain the client's signature if alert and oriented. 3. Send the client to the operating room with documentation. 4. Notify the provider ad operating room staff to cancel the procedure. - 4. Notify the provider ad operating room staff to cancel the procedure. A nurse plans care for a client who is pregnant and practices the theory of hot and cold. Which food sections may be served? (SATA) 1. Cereal and milk 2. Yogurt and fruit 3. Steak and potato 4. Chili and crackers 5. Hot tea with ginger - 1. Cereal and milk 2. Yogurt and fruit A nurse provides discharge teaching to an older adult about fall prevention measures in the home. Which instructions should be included? (SATA) 1. Install grab-bars in the shower. 2. Wear shoes inside the house. 3. Use small rigs in the bedroom. 4. Mark stairs-step edges with colored tape. 5. Keep frequently used items within reach. - 1. Install grab-bars in the shower. 2. Wear shoes inside the house. 4. Mark stairs-step edges with colored tape. 5. Keep frequently used items within reach. A nurse provides care to a client who has celiac disease. Which of the following choices would be an appropriate snack? 1. Corn chips and salsa. 2. Pretzels and hummus. 3. Pastrami with rye bread. 4. Cheese spread on crackers. - 1. Corn chips and salsa. A nurse assists an older adult client with selecting kosher foods from the dietary menu. Which options should the nurse expect the client to choose? (SATA) 1. Orange 2. Milkshake 3. Shrimp salad 4. Chili with beef 5. Hardboiled egg - 1. Orange 2. Milkshake 4. Chili with beef 5. Hardboiled egg The school nurse suspects that a junior high student may have anorexia nervosa. This eating disorder is characterized by: 1. A lack of control over overeating patterns. 2. Self-imposed starvation. 3. Binge/purge cycles. 4. Excessive exercise. - 2. Self-imposed starvation. After a surgical procedure, the client is advanced to a full liquid diet. The nurse is able to recommend which one of the following foods for this client? 1. Custard. 2. Pureed meats. 3. Soft fresh fruit. 4. Canned soup. - 1. Custard. The nurse is speaking with parents of a child at a day-care center. The parents ask the nurse about the nutritional needs of their toddler. An appropriate ginger food that is identified by the nurse is: 1. Nuts. 2. Popcorn. 3. Cheerios. 4. Hot dogs. - 3. Cheerios. When introducing a feeding to a client with an indwelling gavage tube for enteral nutrition, the nurse should first: 1. Irrigate the tube with normal saline solution. 2. Check to see that the tube is properly placed. 3. Place the client in a supine position. 4. Introduce some water before giving the liquid nourishment. - 2. Check to see that the tube is properly placed. An older adult client is scheduled for intermittent tube feedings by syringe. To ensure client safety during administration of the feeding, the nurse should take which of the following actions? 1. Unclamp the feeding tube and then connect the syringe to it. 2. Heat the formula before administering the feeding. 3. Verify there is no more than 300 mL residual prior to the feeding. 4. Pour the formula into the syringe, raising or lowering it as needed. - 4. Pour the formula into the syringe, raising or lowering it as needed. ANTIDOATE FOR: Acetaminophen - Acetylcysteine ANTIDOATE FOR: Benzodiazepine - Flumazenil ANTIDOATE FOR: Curare - Edrophonium ANTIDOATE FOR: Cyanide Poisoning - Methylene Blue ANTIDOATE FOR: Digitalis - Digoxin Immune FAB ANTIDOATE FOR: Ethylene Poisoning - Fomepizole ANTIDOATE FOR: Heparin and Enoxaparin - Protamine Sulfate ANTIDOATE FOR: Iron - Deferoxamine ANTIDOATE FOR: Lead - Succimer ANTIDOATE FOR: Magnesium Sulfate - Calcium Gluconate 10% ANTIDOATE FOR: Narcotics - Naloxone ANTIDOATE FOR: Warfarin - Phytonadione Side effects and adverse reactions for: ACE inhibitors - Angioedema Side effects and adverse reactions for: Benzodiazepines - Anterograde amnesia Side effects and adverse reactions for: Beta Blockers - Bronchospasm Side effects and adverse reactions for: Ciprofloxacin - Tendon Rupture Side effects and adverse reactions for: Digoxin - Yellow tinge to vision Side effects and adverse reactions for: Docycycline - Tooth discoloration Side effects and adverse reactions for: Furosemide - Hypokalemia Side effects and adverse reactions for: Lithium - Tremors Side effects and adverse reactions for: Tobramycin - Ototoxicity Side effects and adverse reactions for: Valacyclovir - Thrombotic thrombocytopenic purpura Therapeutic & Toxic Drug Levels Digoxin - Therapeutic 0.8 to 2.0 ng/mL Toxic > 2.4 ng/mL Therapeutic & Toxic Drug Levels Lithium - Therapeutic 0.4 to 1.4 mEq/mL Toxic > 2.0 mEq/mL Therapeutic & Toxic Drug Levels Phenytoin - Therapeutic 10 to 20 mcg/mL Toxic > 30 mcg/mL Therapeutic & Toxic Drug Levels Magnesium Sulfate - Therapeutic 4 to 8 mg/dL Toxic > 9 mg/dL Medication Categories "ending" ACE Inhibitors - ACE Inhibitors - PRIL Medication Categories "ending" Antivirals - Antivirals - VIR Medication Categories "ending" Antifungals - Antifungals - AZOLE Medication Categories "ending" Antilipidemic - Antilipidemic - STATIN Medication Categories "ending" Angiotensin II receptor blockers (ARBs) - Angiotensin II receptor blockers (ARBs) - SARTAN Medication Categories "ending" Beta-Blockers - Beta-Blockers - OLOL Medication Categories "ending" Calcium Channel Blockers - Calcium Channel Blockers - DIPINE Medication Categories "ending" Erectile Dysfunction - Erectile Dysfunction - AFIL Medication Categories "ending" Histamine receptor antagonists - Histamine receptor antagonists - DINE Medication Categories "ending" Proton Pump Inhibitors - Proton Pump Inhibitors - PRAZOLE A nurse prepares to perform a heel stick to evaluate blood glucose for an infant. Which action should be used to minimize pain? 1. Warm the lateral surface to the foot for 5 minutes. 2. Apply a eutectic mixture of location anesthetic (EMLA) 1 hour before the procedure. 3. Allow the skin to dry after cleansing with mild friction. 4. Encourage the mother to breastfeed the infant during the procedure. - 4. Encourage the mother to breastfeed the i