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Top 5 NCLEX RN Review Tips And Practice Test Questions: “How To Pass And ‘Jump Start’ Your Registered Nursing Career Now”
You’ve spent two or more years of your life preparing for your dream job as a Registered Nurse. You may not feel 100% confident your NCLEX review to pass your RN exam. Failing your nursing exam can delay your career and cost you lost time and registered nurse salary.
Already took your NCSBN test? Did the NCLEX questions leave you with a sinking feeling in your stomach as you left the testing center? If so, you know you need a more effective NCLEX RN review course, practice questions and prep materials.
Whether you have taken the National Council Licensure Examination for Registered Nurses (NCLEX-RN exam) or not, the fear of this test can be almost paralyzing. The good news is that you can overcome this fear, pass the exam, and become a Registered Nurse.
Click here to: See The 7 Worst NCLEX Test Prep Mistakes
NCLEX review questions and practice tests that help you see the real exam in advance help you raise your score to passing fastest. Use NCLEX practice questions that are worded, formatted and structured like the exam. Find comprehensive NCLEX prep books that cover the complete 2014 Test Plan.
A Critical NCLEX Question…How Much Study Time Do You Need To Pass?
Everyone who prepares for this RN exam fears failure. Every year, there are a certain number of applicants who fail their RN licensure examination.
The National Council of State Boards of Nursing (NCSBN), the organization that represents the boards responsible for licensing nurses, reports that the pass rate for the exam is 75-80% of all applicants. The pass rate for first-time takers of the exam is even higher. Your nursing school will also be able to tell you what their pass rate is. If your college’s pass rate is high, you have many of the fundamentals in place to begin an effective review.
If your university’s pass rate is low, start studying for the NCLEX RN exam at least 3 full months before your testing date.
Studies show that students who fail the exam are those who did not identify a good NCLEX review plan prior to taking the exam. This 5 step process will guarantee your review for NCLEX helps you become a Registered Nurse.
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1.) Use NCLEX Practice Questions To Learn The Format And Structure Of Your Registered Nurse Exam
Research studies in test prep and standardized tests reveal that knowing the general organization of a test and organizing your studies based on that can help lower anxiety and raise your score. NCLEX-RN questions are organized into four major categories in the NCSBN Test Plan.
Every nurse who has ever prepared for this exam will tell you that they had one or two areas of weakness. Perhaps it was the class in school that was hardest for you…or the class in which you got the worst grade. You can use NCLEX sample questions as a diagnostic tool to get aware of which categories are the most problematic for you.
After identifying the categories where you are weak, focus at least 80% of your NCLEX prep time on those specific areas of the exam. Reading hundreds and hundreds of page in your study guide can become monotonous. The longer you read, highlight and underline your book, the less you absorb and less productive your study session.
Use sample NCLEX questions at least 50% of the time during your review sessions. You’ll be learning in an interactively and actively, retain more test content and get actual NCLEX practice all at the same time.
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Only use NCLEX RN practice questions that address the category or categories where you need to the most improvement in.
NCLEX-RN exam question categories include:
Safe and Effective Care Environment
Management of Care
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity
Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
Click Here: To See My Embarrassing NCLEX Testing Story
2.) Get NCLEX Practice Questions That Cover All RN Test Question/Answer Formats
Your nursing assessment is composed of different types of NCLEX RN questions. These question and answer formats are completely unlike any took in college or any other standardized test. Warning: Do not wait until you’re only a few days from your exam day to learn the different types of questions. Don’t delay developing the critical test taking skills you need to pass.
Most of the RN test questions are multiple choice questions with one “most correct” answer out of four possible responses. However, you need to be aware that there are several other types of questions you will find on the test.
Before you begin the test, there will be a short tutorial that will show you each of the different types of questions. To ensure your success, take NCLEX RN practice questions in these various question and answer structures. In your NCLEX review, be sure to use a variety of sample questions that allow you to feel comfortable with any of the eight types:
Multiple Choice – This is the standard and most common type of questions on the NCLEX. For this question type, there is a question with four possible answers. Only one of the answers is the best response. Note that the responses may ALL be correct so be sure to read the question and look for the best answer to the question.
Multiple Response – This type of NCSBN question is arguably the hardest type to answer. In this type, you’ll see a question with a list of possible responses. The hard part is that you must select ALL of the correct answers to the question. You won’t get partial credit for having some of the correct responses. The best way to deal with this type is to read the question and each response individually then decide if that one response is correct or not. Do the same for each of the possible answers. Don’t over think on this type of question – go with your initial instinct on each response. Make sure your prep questions contain some of this type of question!
Calculations – Chiefly used in the pharmacology questions, this type of RN exam question will ask you to do a calculation and fill in the answer. An on-line calculator is provided for these questions. However, be sure to review drug and weight calculations before going into the NCLEX exam. Your NCLEX practice test questions should contain several calculation type questions.
Charts and graphs – This is variation on the multiple choice questions. You’ll be presented with a chart of information that will be critical in answering the question. You will still see 4 possible choices but you will also see some sort of chart that should help you determine the correct answer. Practice reading graphs and charts 2-4 weeks before your test date.
Graphic item – In this question type, you’ll see a question and then 4 possible choices that are pictures. You’ll select the picture that is the best response to the question.
Ordered Response – The ordered response NCLEX question type will give you a scenario and a list of interventions. The question will ask you to place the responses in the correct order based on the most important to least important. This type of question really tests your ability to prioritize your work based on the nursing process, Maslow’s hierarchy, and what a Registered Nurse can and cannot delegate.
“Hot Spot” – In the “hot spot” question type, you will see a question and a body figure. The question will ask you to click on the area of the figure that represents the correct answer. For example, the question might ask you to click on the place where you could auscultate a certain heart sound. Using your mouse, you will click on the correct spot of the figure.
Audio – Finally, an audio NCLEX test question will require that you listen to an audio clip and then select one of the 4 possible answers to a question. For example, you might listen to an audio recording of lung sounds; the question might ask what kind of breath sounds you heard. There will be 4 choices and you will select the correct response.
In order to become familiar with this question type, be sure at least some of your NCLEX RN review questions are available on a CD or DVD.
3.) Don’t Over Analyze NCLEX Questions
Remember that the NCLEX-RN exam is a test of BASIC nursing knowledge. Even if you do not know the disease process in the question, the question usually is NOT testing your knowledge of the disease. Instead, the questions are testing your ability to use your reasoning and critical thinking skills. Look for those words in the answers that will help you exclude a particular response. If a response includes the words “always” or “never”, you can usually throw out that answer. If two responses are very similar, it is likely that one of those responses is the correct one so you can concentrate on those.
Watch for the word “not” in the question and look for the response that is wrong! If you can exclude one or more responses, even if you are not sure of the answer, your odds of getting the question correct go way up!
As you work with more and more NCLEX RN prep questions, you will begin to understand that they are really just looking for the most basic of knowledge – but all of the questions will be testing your ability to think.
4.) Think Like A Registered Nurse
Know the nursing process! Look at NCLEX practice questions in any book or website and you will begin to understand that, in some way or another, most of the questions will be testing your knowledge of the nursing process. Look for NCLEX review questions that have to do with delegating patient care to personnel with a lower level license or with no license at all.
As you work on practice questions, try to determine what part of the nursing process is being addressed:
Assessment of the patient’s needs
Establishing the nursing diagnosis based on the patient’s needs
Planning the patient’s care
Implementing the care plan
Evaluating the success of the plan
Go to: FREE Prep Guide To Pass Your Registered Nurse Exam
5.) Understand Maslow’s Hierarchy of Needs
Many NCLEX questions are centered around Maslow’s Hierarchy of Needs. You learned about it in nursing school and you’ll use this hierarchy for the rest of your nursing career.
This hierarchy will be directly reflected in many questions on the NCLEX exam when you are asked to prioritize interventions or select the best response from a list of “correct” responses! Always choose the response that reflects the most basic need in the list. Just as a reminder, the levels of Maslow’s hierarchy from most basic to the highest level are:
Physiological – These basic survival requirements must always be met first. If one of the responses to a question on the NCLEX has to do with food, water, oxygenation or some other basic physical need, that is probably the correct response.
Safety – Once physical needs are met, the safety and predictability needs will be the next most basic.
Love and Belonging – These needs include the need for intimacy and belonging to a group.
Esteem – Including both self-esteem and the esteem of others, these needs will become the most important when the other three levels of needs are adequately met.
Self-actualization – At the top of the pyramid, self-actualization needs include feeling fulfilled and realizing an individual’s potential.
Take the First 2 NCLEX Prep Steps Now
Use the free NCLEX RN practice questions below to learn the 2014 Test Plan and get familiar with the types of questions you’ll see on your testing date. The official NCSBN website has many good practice questions and information about the NCLEX test. The first step in NCLEX review must be understanding how the test is built and material you’ll be tested on.
Whatever NCLEX-RN review study guides and practice exam questions you use, be sure your resource has a variety of types of questions this test will throw at you in the exam center. If you can go through interactive practice questions electronically, that’s even more effective.
You will be taking your test on a computer so the more realistic your practice, the more prepared you will be. Remember, previous behavior patterns will prevent you from creating new ones. Begin now to change your process for preparing for the NCLEX-RN exam.
RN Test Study Resources
National Council of State Boards of Nursing (NCSBN) website, including:
https://www.ncsbn.org/1232.htm
https://www.ncsbn.org/index.htm
https://www.ncsbn.org/2013_NCLEX_RN_Detailed_Test_Plan_Candidate.pdf
Maslow’s Hierarchy of Needs:
http://howlandpowpak.neomin.org/powpak/cgi-bin/article_display_page.pl?id=thomas.williams&ar=6
Monster.com:
http://nursinglink.monster.com/education/articles/4770-failed-the-nclex-4-strategies-that-will-put-you-back-on-track
NCLEX-RN.net, including:
http://www.nclex-rn.net/nclex/messages2006a/147737.html
Lippincott’s Nursing Center:
http://www.nursingcenter.com/lnc/journalarticle?Article_ID=648205
Two Peas in a Bucket for information about the fear of failure:
http://www.twopeasinabucket.com/mb.asp?cmd=display&forum_id=0&thread_id=2828778
Visit: How To Pass The NCLEX RN Easier And Start Your Nursing Career Now
Free NCLEX RN Practice Test Questions Online
Safe and Effective Care Environment: Management of Care Questions
A judge has signed an involuntary commitment to a psychiatric hospital for a 25-year-old patient who is considered dangerous to himself and others in the community. The nurse knows that this patient has lost the right to:
Send and receive private mail.
Refuse to take medications.
Leave the hospital against medical advice (AMA).
Be free from the use of restraints or seclusion.
The correct response is “C”. Unless there is additional court action, the only right lost by an individual involuntarily committed is the right to leave the hospital against medical advice. The patient’s behavior after commitment may dictate loss of other rights. For example, a patient who becomes a danger to staff may be secluded.
The Emergency Department staff has participated in an aggression management course sponsored by the hospital. The best measure to evaluate the effectiveness of this program would be reduction of:
Patient complaints about restraint application.
Number of restraint procedures needed.
Staff injuries during application of restraints.
Patient injuries during application of restraints.
The correct response is “B”. Aggression management courses should teach staff how to de-escalate a situation and prevent violence. If the number of restraint procedures is reduced by preventing escalation of a situation, staff and patient injuries and patient complaints about restraint application will also be reduced.
The Emergency Department triage nurse is presented with four patients waiting to be seen. Place the patients in the order they should be seen.
A 3-year-old patient who has fallen into a barbed wire fence sustaining multiple puncture wounds to his lower extremities. The child is crying but is breathing well and bleeding is minimal.
A 28 week pregnant woman who needs help finding a new obstetrician.
A crying mother of a 1-month old who is worried about her desire to shake her newborn because he “cries all the time”.
A 45-year-old rancher with a rattlesnake bite to his left hand.
The correct order for these patients is “D, C, A, B”. The man with the rattlesnake bite has a potentially life or limb-threatening problem that must be treated quickly. The crying mother of a 1-month-old should be seen second since she is exhibiting signs of post-partum depression. This diagnosis may put the infant at risk for abuse. The nurse should keep an eye on the 3-year-old with multiple puncture wounds but, as long as his condition does not change, he does not have a life-threatening problem. Finally, the 28-week pregnant woman without other symptoms simply needs a referral to an obstetrician so can safely wait until the other patients are seen.
The patient with pneumonia is being discharged to home with a prescription for an as-needed cough medication. The patient reports that she does not have the money to pay for the prescription. The appropriate referral would be to:
The hospital social worker.
The hospital billing office.
The patient’s insurance company.
The pharmacist at a local pharmacy.
The correct response is “A”. One of the jobs of the social worker is to help patients find resources in the community that will help the patient obtain the needed medication. The billing office, pharmacist and insurance company will typically refer the patient back to the discharging hospital unit.
The ICU nurse is part of the Quality Improvement team looking at improving care and safety in the unit. Projects that might be appropriate for this team include (Select all that apply):
Visitation policies.
Effective transfer policies.
Hand hygiene compliance.
Implementation of recycling cans in the unit.
Correct responses are “A, B, and C”. Implementation of recycling on the unit will NOT have an impact on quality care and patient safety. Visitation policies can have an impact on patient safety by limiting visits from young children and requiring masks for anyone with symptoms of illness. Transfer policies that outline information that should be shared at the time of transfer will promote quality care and safety by ensuring continuity of care. Since hand washing is the single most important intervention for preventing cross-infection, a hand hygiene compliance study can identify processes that can be improved.
An 18-year-old high school student is seeking treatment for a possible venereal disease. He is covered on his parents’ insurance policy and wants that insurance used for this visit. However, he does NOT want information about his diagnosis disclosed to his parents. The nurse should inform the patient that, according to the Health Information Portability and Accountability Act (HIPAA), his parents:
Cannot access the medical record but may learn of the visit through insurance billing.
Cannot access his record or the insurance bill for the visit.
May review his medical record since the parents’ insurance is being billed.
May review his medical record until he is out of school.
The correct response is “A”. As an adult, an 18-year-old can expect privacy in regards to his medical record, but since his parents’ insurance is being billed, they will receive a benefits statement that will include the fact that he received medical care. The fact that he is still in high school does not have any bearing on this fact. In order to review his medical record, the student must give the hospital or clinic permission to allow his parents to view the record.
The nurse is part of a Quality Improvement team that will be doing a project using the Plan, Do, Study, Act (PDSA) methodology to study falls on her unit. What is the correct order of steps in this project?
Audit charts.
Decide to test a certain fall scale
Write and implement a new falls scale policy.
Analyze the data collected.
The correct order is “B, A, D, C”. During the planning stage, the team will determine what to test. Data collection in the form of a chart review is part of the “Do” phase of the project. Doing the data analysis after collection is the “Study” phase. During the “Act” phase, a new process or policy may be implemented. Follow up will also be done and the PDSA cycle will begin again.
A patient has been transferred out of the Intensive Care Unit after open-heart surgery. The team on the floor consists of a Registered Nurse and Licensed Practical Nurse (LPN). Select all of the tasks that can be delegated to the LPN.
Assessing pain and administering IV morphine when needed.
Administering scheduled oral medications.
Bath and oral care.
Discharge teaching.
Taking vital signs.
The correct responses are “B, C, E”. Although state regulations and hospital policy must be followed, LPNs have been trained to administer oral medications, perform hygiene care, and take vital signs. Assessment must never be delegated to an LPN. Planning and discharge teaching must also be completed by the RN.
The Registered Nurse (RN) on the Medical Surgical unit is working with an unlicensed aide. The tasks that can be delegated to the aide are (select all that apply):
Provide nutritional teaching.
Measure and record intake and output.
Auscultate bowel sounds.
Assist the patient to the bathroom.
Take verbal orders for a medication change.
The correct responses are “B and D”. Teaching and assessment must never be delegated to unlicensed personnel. Physician orders should not be taken as verbal orders and should NEVER be taken by an unlicensed person. Recording of intake and output and assisting with ambulation can be delegated.
A 16-year-old psychiatric patient does not want his parents to have access to his medical record. The patient’s mother asks to review his chart. The nurse does not know how to respond to the parent. The best person for the nurse to consult is:
The chair of the hospital’s ethics committee.
The patient’s physician.
The hospital’s privacy officer.
The charge nurse.
The correct response is “C”. According to the Health Insurance Portability and Accountability Act (HIPAA), each healthcare agency must have a privacy officer who understands and implements all privacy policies. The patient’s physician and the charge nurse may or may not understand HIPAA and privacy regulations. The chair of the ethics committee may understand the ethical considerations, but may not be able to assist with the HIPAA concerns.
Infection Control And Safety
You are the registered nurse in charge of a group of 30 clients. You have registered nurses (RNs), licensed practical nurses/licensed vocational nurses (LPNs/LVNs) and nursing assistants as part of your nursing care team.
The nursing assistant, who is taking vital signs, reports to you that one of the clients, Mrs. B, has a temperature of 102° F. Mrs. B has a known nosocomial methicillin resistant staphylococcus aureus (MRSA) infection of her abdominal surgical wound. She began intravenous antimicrobial therapy 12 hours ago and is having wound irrigations and dressing changes BID. Hourly urines are being monitored; and the client has out of bed activity.
Mrs. B’s temperature is ____° C.
Answer: 38.9 ° C
Rationale: Centigrade conversion to Fahrenheit: ° C x 9/5 and then add 32
Fahrenheit conversion to centigrade: ° F – 32 x 5 and then divided by 9
102 ° F – 32 = 70
70 x 5 = 350/9 = 38.9 ° C
Assessment (Phase of the nursing process), Application (Level of the cognitive domain), Fill in Blank (NCLEX question format)
Which aspects of care for Mrs. B can be delegated below? (Select all that apply).
Monitoring hourly urines: Nursing assistant
Monitoring hourly urines: LPN/LVN
Evaluating the outcomes of the antibiotic therapy: RN
Evaluating the outcomes of the antibiotic therapy: LPN/LVN
Infected wound irrigation: LPN/LVN
Infected wound irrigation: Nursing assistant
Assessing urinary output: Nursing assistant
Answer: A, B, C, E
Rationale:
Nursing assistants and other unlicensed assistive staff can monitor hourly urines as part of their scope of practice. LPNs/LVNs can monitor hourly urines and irrigate wounds as part of their scope of practice. Only the registered nurse, however, can evaluate the outcomes of antibiotic therapy and assess urinary output. Nursing assistants and LPNs/LVNs can provide data relating to urinary output when they report and document hourly urinary output, and LPNs/LVNs can provide data relating to client responses to antibiotic therapy, but it is only the registered nurse that organizes and analyzes this data using the professional judgment and critical thinking necessary for assessment and evaluation.
Implementation Synthesis (Delegation) Multiple Correct Responses
Those providing care to Mrs. B must use personal protective equipment to prevent:
Immunosuppression.
Airborne transmission of MRSA.
Antimicrobial resistance.
Noscomial infections.
Answer: D
Rationale:
Personal protective equipment is used to not only protect the infected client and the nurse from infections, but also to prevent the spread of infection to other clients in the facility (nosocomial infections). MRSA is not airborne; and personal protective equipment has no impact on antimicrobial resistance or immunosuppression.
Implementation Application Traditional Multiple Choice
The nursing assistant is instructing Mrs. B’s family how to hand wash properly before and after leaving the family member’s room. What sequence of hand washing should the nursing assistant be using during this instruction? Select each correct step of the hand washing procedure and then put the correct steps in sequential order.
Thoroughly wet the hands under the running water while the hands are higher than the elbows.
Quickly turn the water on put soap on the hands, then turn it off.
Rub the soapy hands together for at least 15 seconds.
Dry the hands off.
Apply the soap to the hands.
Turn the water off with a paper towel
Turn the water on and adjust the flow
Thoroughly wet the hands under the running water while the hands are lower than the elbows.
Rub the soapy hands together for at least 10 seconds.
Answer: G,H, E, C, D, F
Rationale:
The purpose of hand washing is to prevent the spread of infection. Hand washing is the single most important thing that nurses can do to prevent the spread of infection. The steps of hand washing are to turn the water on, moisten the hands while keeping the hands lower, not higher, than the elbows, apply soap to the hands, rub all surfaces of the hands together for at 15, not 10, seconds, then rinse the hands with the hands, again, lower than the elbows, and then finally turn the water off with a paper towel, rather than the clean hands.
Implementation Application Sequence
5. Select the personal protective equipment that is necessary when caring for a client with an MRSA infected wound.
A.)
B.)
C.)
D.)
E.)
F.)
Rationale: A protective gown and gloves are necessary when caring for a client with MRSA. MRSA is spread with contact; it is not an airborne or droplet infection, so the use of goggles, surgical masks, bonnets, and respirators, like the N 95 respirator are not necessary.
Application Implementation Diagram/Figure
6. Select all of the risk factors that can impact on the patient’s safety in the healthcare environment.
Fear of falling
Level of development
Gender
Ambient temperature
Confusion
Medications
Previous occupation
Sensory alterations
Answer: A, B, E, F, H
Rationale:
Some of the risk factors that affect a patient’s safety in the healthcare environment include fear of falling, which places the patient at risk for falls, age because the very young and the elderly are more at risk for injuries and accidents than other age groups, confusion, like that which occurs with anesthesia, delirium and dementia, some medications, and sensory deficits such as visual and auditory alterations, place patients at risk for falls. Previous occupations, gender and ambient environmental temperatures have no impact on patients’ safety risks.
Application Assessment Multiple Correct Responses
7. You are the Assistant Director of Nursing in a long term care facility. Most of the residents are elderly and with chronic illnesses. You have recently implemented a falls risk management program. This program includes the routine screening of all clients for falls risk, the complete assessment of clients who were screened at risk for falls and the initiation of special preventive measures to reduce the risk of falls among clients who are identified as at risk for falls. Which aspects of this falls risk management program can be delegated on a daily basis to the RNs, LPNs/LVNs and nursing assistants on each of the long term care facility’s nursing units? Select all that apply.
Monitoring the residents for risky behaviors: Nursing assistant
Assessing residents for falls risk: LPN/LVN
Collecting data relating to resident’s falls risk: LPN/LVN
Developing a performance improvement study relating to the falls risk management program: RN
Implementing preventive strategies to prevent falls: LPN/LVN
Applying restraints in an emergency situation: All levels of staff
Applying an ordered restraint: LPN/LVN
Answer: A, C, D, E, G
Rationale:
The nursing assistant, according to their scope of practice, can observe, monitor and report patient behaviors like safety risk behaviors; LPNs/LVNs can implement planned preventive strategies, they can collect data relating to falls risk, and their can apply an ordered restraint, but, they cannot assess residents for falls risk nor apply a restraint in an emergency situation without an order. Only the RN can initiate the use of restraint in an emergency situation without a doctor’s order and only the RN can assess patients for falls risk, using data contributed by other members of the nursing team.
Application Synthesis (Delegation) Multiple Correct Responses
8. Select the type of fire extinguisher that is correctly paired with the type of fire it can safely extinguish.
Type A fire extinguisher: Electric
Type B fire extinguisher: Grease
Type C fire extinguisher: Wood
Type D fire extinguisher: All types of fires
Answer: B
Rationale:
A type A fire extinguisher is used on ordinary fires like wood and paper; a type B fire extinguisher is used to extinguish flammable gas, grease and liquid fires; a type C extinguisher is used for electrical fires; and a type ABC fire extinguisher puts out all types of fires.
Application Implementation Traditional Multiple Choice
9. A small fire has broken out in the employee cafeteria. Number each of these interventions in the proper sequence.
Extinguish it with a fire extinguisher.
Pull the fire alarm.
Close any doors.
Dial the hospital operator.
Call out for help.
Rescue any people in imminent danger.
Answer: F, B, C, A
Rationale:
The RACE procedure establishes the priority steps for reacting to a fire. R is rescue people in imminent danger, A is pulling the fire alarm, C is containing the fire by closing doors, and E is extinguishing the fire if it is safe to do so. Calling the hospital operator and calling aloud for help are not part of the established RACE procedure.
Application Implementation (Priority Setting) Sequence/Order
10. Identify each of these symbols.
A.)
B.)
C.)
D.)
E.)
Answer:
Poison
Radioactivity
Wet floor or another hazard
Blast danger
Electrical danger
Rationale: These universal safety warning symbols must be readily recognized by all people, including healthcare providers like nurses. Application Assessment Diagram/Figure
Physiological Integrity: Basic Care and Comfort
The nurse is caring for a cancer patient with bone pain. Which part of a pain assessment is most significant for this patient?
Location.
Intensity.
Cause.
Exacerbating factors.
The correct response is “B”. Intensity attempts to measure the severity of pain and is important when evaluating whether or not pain is being managed. In this case, the cause and location of the pain cannot be managed, but the nurse may be able to control the intensity of the pain. The nurse may be able to help control exacerbating factors; however, the goal of treatment should be to reduce the intensity of the pain.
The patient with low back injury is trying to get out of bed. She abruptly stops because of low back pain radiating down to her heel and foot. Prioritize the interventions that the nurse should do from most helpful to least helpful.
Apply a warm compress to her back.
Call the physician immediately
Assist the patient to lie down.
Administer the ordered pain medication.
The correct order is “C, D, A, B”. The patient’s immediate safety should be the first priority so the nurse should help the patient back to bed. Relief of the pain should be the second priority. The nurse should administer the pain medication. A warm compress on the back may also help to relieve pain by relaxing the patient’s muscles. Finally, the nurse should notify the physician of the actions that have been taken and the results of the interventions.
The patient is four days post-operative after internal fixation of a C4– C5 neck fracture. The nurse is preparing to move the patient into a wheelchair. The nurse should be sure that the wheelchair has which of the following features? Select all that apply.
The patient should be able to control the wheelchair by his breath.
The seat of the wheelchair should be lower than normal.
The seat of the wheelchair should have firm cushions.
The back of the wheelchair should be at the level of the patient’s shoulder blades.
The back and head of the wheelchair should be at the level of the patient’s head.
The correct responses are “A, B, E”. Because of the level of injury, this patient will not be able to use his arms and will need a wheelchair that can be controlled with his breath. The seat of the wheelchair should be lower than normal to allow easier transfer from bed or chair to the wheelchair. A firm wheelchair cushion may add pressure to the bony pelvis. The wheelchair should be padded instead of firm. The patient with a C4– C5 fracture will have neck control but may tire quickly while trying to hold up his head. The back of the wheelchair should be high enough to provide neck and head support.
The nurse is teaching a new nursing assistant how to provide oral care to a patient who cannot do this for herself. Which of the following techniques should the nurse tell the assistant to use for the patient’s oral care?
Assess the oral cavity each time mouth care is given and record observations.
Swab the patient’s tongue, gums, and lips with a soft foam applicator every 2 hours.
Rinse the patient’s mouth with mouthwash several times a day.
Use a soft toothbrush to brush the patient’s teeth after each meal.
The correct response is “D”. The assistant should understand that swabbing with a foam applicator or rinsing with mouthwash are not enough to clean the patient’s teeth and gums. Instead, the mechanical action of a soft toothbrush is better suited to remove debris and maintain oral health. Although the assistant should report any changes or potential issues in a patient’s mouth, assessment and documentation cannot be delegated by the RN to a non-licensed person.
The nurse is caring for a patient with acute coronary syndrome. The physician has prescribed a low cholesterol diet. Which meal would indicate that the patient understands the restrictions of this diet?
Hamburger, French fries, and milk.
Baked liver, green beans, and coffee.
Pasta with tomato sauce, salad, and coffee.
Fried chicken, baked beans, and iced tea.
The correct response is “C”. Pasta, tomato sauce, and salad are all foods low in cholesterol. Hamburger, French fries, liver and fried chicken are foods that are much higher in cholesterol.
Physiological Integrity: Pharmacological and Parenteral Therapies
A patient who weighs 220 pounds has an order for 1.5 mg/ kg of gentamicin sulfate IV in each dose of the medicine. How many milligrams of gentamicin should the nurse administer for each dose? ____________________________________ Mg.
The correct response is 150 mg. First, convert pounds to kilograms by dividing 220 pounds by 2.2 pounds/kg to get the patient’s weight as 100 kg. Next, multiply 100 kg times 1.5 mg/kg as ordered = 150 mg of gentamicin in each dose.
The patient has been prescribed ibuprofen for his arthritis. In order to minimize possible stomach upset, the nurse should instruct the patient to take the medication:
Before going to bed.
After getting out of bed in the morning
Immediately after a meal on a full stomach.
Two hours before a meal on an empty stomach.
The correct response is “C”. Ibuprofen is known to cause stomach upset when taken on an empty stomach. Taking the medication on a full stomach will generally help decrease stomach upset. Because of the potential for irritation of the stomach and resulting esophageal reflux, this patient should not take the ibuprofen before he goes to bed.
When teaching a patient about acetaminophen that has been prescribed for minor to moderate pain, which information should the nurse expect to include? Select all that apply.
Acetaminophen can be used if the person is allergic to aspirin.
Acetaminophen does not affect platelet aggregation.
Acetaminophen does not usually cause gastric upset.
Acetaminophen exerts a strong anti-inflammatory effect.
The patient should have the international normalized ratio (INR) checked regularly.
The correct responses are “A, B, C”. Acetaminophen is an alternative for a client who is allergic to aspirin. It does not affect platelet aggregation and the client does not need to have coagulation studies (such as INR). Acetaminophen causes little or no gastric distress. Acetaminophen is not an anti-inflammatory.
The nurse is giving discharge instructions to the patient with chronic pain due to cancer whose pain is fairly well controlled on an oral opioid. Which of the following recommendations would be most effective for pain control for this patient?
“Expect some pain and use the minimum amount of medication to keep from being addicted.”
“Take the prescribed medicine only when pain is severe.”
“Take enough of the pain medicine so that you can sleep 12 to 16 hours a day to sleep through the pain episodes.”
“Take the prescribed pain medicine on a regular basis around the clock to prevent recurrent pain.”
The correct response is “D”. For chronic pain that is well-controlled on medication, taking the medication on a regular basis will maintain a therapeutic blood level of the medication. This should help prevent “breakthrough” pain that happens when the blood level of the medication falls below a therapeutic range. The regular administration of analgesics provides a consistent serum level of medication, which can help prevent breakthrough pain. A patient with cancer pain rarely becomes addicted to pain medication. If the patient is sleeping more than twelve hours each day, the blood level of the pain medicine will undoubtedly be erratic leading to “breakthrough” pain. In addition, this overly sedated patient will not be able to enjoy his usual level of activity potentially resulting in decreased quality of life.
The nurse is teaching a 48-year-old patient to administer the anticoagulant enoxaparin by subcutaneous injection following a knee replacement. Instructions to this patient should include: (Select all that apply)
Notify your healthcare provider immediately for any difficulty breathing, rash, or itching.
Notify your healthcare provider of unusual bruising.
Avoid all aspirin-containing medications except those prescribed by the healthcare provider.
Wear or carry medical alert identification.
Carefully remove the needle from the syringe after the injection.
The correct responses are “A, B, C, D”. Enoxaparin (Lovenox) is an anticoagulant that carries with it risks of sensitivity and bleeding. As such it is a high-risk medication. The patient and family should watch for signs of allergic reaction and bleeding and should report any of these symptoms to the prescribing provider. The patient should be advised to avoid any other medications that can cause bleeding including aspirin and NSAIDs. Because of the risk of bleeding, the patient should carry a medical alert bracelet, necklace or card. No patient or family member should ever be advised to remove a needle from a syringe due to the risk of needle-stick injury.
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PHYSIOLOGICAL INTEGRITY: Reduction Of Risk Potential
Physiological homeostasis maintains the body’s constant and stable condition with which of the following homeostatic mechanisms? Select all that apply.
Atrophy
Counterbalancing
Negative feedback
Positive feedback
Increased production of white cells
Increased production of red cells
Self regulation
Answer: B, C, D, G
Rationale:
Physiological homeostasis maintains the body’s constant and stable condition with homeostatic mechanisms that include counterbalancing, or compensatory mechanisms, negative and positive feedback in an open system, and self-regulation. The body, as an open system, controls a stable internal environment, despite the ever changing external environment, with input, throughput and output.
Hematological integrity and homeostasis results from maintaining:
The blood pH from 7.10 to 7.90.
Blood potassium from 3.5 mEq/L to 4.5 mEq/L.
Blood sodium from 135 mEq/L to 145 mEq/L.
Phosphate from 2.5 mg/dL and 3.5 mg/dL.
Answer: C
Rationale: Hematological integrity and homeostasis results from maintaining the blood sodium from 135 mEq/L to 145 mEq/L. Levels less than 135 mEq/L indicates hyponatremia; and levels greater than 145 mEq/L is hypernatremia. The normal level of potassium is from 3.5 mEq/L to 5.0 mEq/L. Levels less than is 3.5 mEq/L is hypokalemia; and levels more than 5.0 is hyperkalemia. Normal blood phosphate levels are between 2.5 mg/dL and 4.5 mg/dL. Levels less than 2.5 mg/dL is hypophosphatemia; and levels greater than 4.5 mg/dL is hyperphosphatemia. The normal pH or the acidity/ alkalinity of blood is from 7.35 to 7.45. Low pH indicates acidic blood; and high pH indicates alkaline blood.
The endocrine system maintains the body’s physiological integrity with feedback mechanisms. Label these nine endocrine glands.
OR
Identify the following endocrine organ.
Answer: (First option for # 3- Can your work with this diagram so the learner can fill in the organ names?)
(Second option for # 3)
Adrenal gland
Pancreas
Thyroid gland
Hypothalamus
Answer: B
Rationale:
The pancreas, one of the endocrine glands, is anatomically located in the abdomen. The pancreas performs digestive functions with the secretion of digestive enzymes; and it also controls metabolic functions with the secretion of insulin from the pancreas’ Islets of Langerhans.
Physiological Integrity: Physiological Adaption
Select the physiological structure or mechanism that facilitates the human body’s adaptation to the changing environment with its correct description. Select all that are accurate and correct.
Bodily temperature control: The hypothalamus
Respirations: The hypothalamus
Bodily temperature control: Cardiac baroreceptors
Respirations: Cardiac baroreceptors
Local infection: Peripheral vascular resistance
General adaptation syndrome: Peripheral vascular resistance
The secretion of thyroid hormone: Hyperactivity of the thyroid gland
The secretion of parathyroid hormone: Hypocalcemia
Answer: A, D, H
Rationale: Bodily temperature control is maintained by the hypothalamus which is located in the brain. Respirations and respiratory rate are controlled by a number of mechanisms including the role of the cardiac baroreceptors which increase respiratory rates when high levels of carbon dioxide are present. Parathyroid secretion is stimulated by falling levels plasma calcium.
Number each of these accurate physiological regulatory actions, or functions, in the correct sequential order. Include only those actions, or functions, that are accurate.
The anterior pituitary releases thyroid stimulating hormone
Thyroid stimulating hormone is modulated by thyrotropin releasing hormone from the hypothalamus
Negative feedback to the posterior pituitary
The posterior pituitary releases thyroid stimulating hormone
Negative feedback to the anterior pituitary
The thyroid gland secretes thyroid hormone
The thyroid gland secretes thyroxin
Answer: E, A, B, F
Rationale:
When the anterior pituitary gland receives negative feedback, it stimulates the production of thyroid stimulating hormone which is modulated by thyrotropin releasing hormone from the hypothalamus. The thyroid gland then secretes thyroid hormone as a result of these actions physiological adaptation mechanisms.
The body’s first line of defense to maintain physiological integrity is:
Leukocyte mobilization.
Macrophage actions.
The inflammatory process.
The integumentary system.
Answer: D
Rationale:
The integumentary system, or the skin, is the body’s first line of defense to maintain physiological integrity. The skin and the mucous membranes are the first line of defense because the intact skin prevents the entry of pathogens, it contains protective natural resident bacteria that ward off harmful bacteria, and it secretes a slightly acidic secretion which inhibits and prevents the growth of pathogenic microorganisms. Leukocytes, macrophages and the inflammatory response are second lines of defense.
Place the following phases of the inflammatory response in correct sequential order.
Increased vascular permeability
The release of histamine
The dilation of the blood vessels and hyperemia
The constriction of the blood vessels
Swelling and pain
Exudate production
The release of chemical mediators like serotonin
The leakage of leukocytes into the interstitial spaces
The reparative phase
Answer: D, B, C, A, G, H, E, F, I
Rationale:
The proper sequence of biological responses to infection is:
The constriction of the blood vessels
The release of histamine
The dilation of the blood vessels and hyperemia
Increased vascular permeability
The release of chemical mediators like serotonin
The leakage of leukocytes into the interstitial spaces
Swelling and pain
Exudate production
The reparative phase
5.) Which of the following depict a risk factor that can compromise physiological integrity? Select all that apply.
A.)
B.)
C.)
D.)
E.)
F.)
Answer: A, B, E, F
Rationale: All invasive procedures and treatments as well as immobility place the person at risk for alterations of physiological integrity. An intravenous administration of fluids, electrolytes, and medications places the patient at risk for infection and other adverse effects. The lack of mobility out of bed and the need for a wheelchair place patients at risk for infections and pressure ulcers, among other things like respiratory compromise, the loss of calcium from the bones, and muscle contractions. Lastly, although many medications are necessary for treatments, they are often accompanied with side effects and adverse effects, some of which can be life threatening. Culturing laboratory specimens and exercise do not place the client at risk for impaired physiological functioning.
6.) Select the risk factor that is accurately paired with its characteristics.
Genetics: An intrinsic, modifiable risk factor.
Obesity: An extrinsic, modifiable risk factor.
Age: An intrinsic, nonmodifiable risk factor.
Cigarette smoke: An extrinsic, nonmodifiable risk factor.
Answer: C
Rationale: Age is an intrinsic, or internal, risk factor for physiological disorders that cannot be changed or modified. Other intrinsic, nonmodifiable risk factors include genetics, gender and ethnic background. Obesity is an intrinsic, modifiable risk factor; and cigarette smoke and cigarette smoking are both modifiable. Passive smoke, an extrinsic, or external, risk factor can be avoided by not going to places that permit cigarette smoking; and active cigarette smoking is intrinsic and not extrinsic.
7.) Select all of the direct risk factors that are associated with skin breakdown.
Shearing
Mottling
Blanched skin
Friction
Moisture
Medications
Answer: A, D, E
Rationale: Mechanical, or physical, forces that place a person at risk for skin breakdown include shearing and friction. Other risk factor are moisture, impaired mobility, poor nutritional status and bed rest. Blanched and reddened skin are signs of actual skin breakdown, and not risk factors. Medications and mottling have no direct effect on skin breakdown.
NCLEX-RN Psychosocial Integrity Practice Questions
A woman pregnant with her first child at 9 weeks gestation comes to the Emergency Department with bright red vaginal bleeding, passing products of conception (POC),
and severe lower abdominal cramping. The nurse anticipates that the woman might be feeling:
Guilt.
Fear.
Hate.
Ambivalence.
The correct response is “A”.
When a woman experiences a spontaneous abortion, she will likely feel a sense of loss that may be accompanied by feelings of guilt.
The woman may question whether there was something she should have done to prevent the miscarriage.
The nurse should help the woman understand that this abortion was not a result of something she did wrong.
Typically, the woman will not experience fear, hate or ambivalence in this situation.
A 4-year old child is scheduled for a removal of a benign tumor on his leg. In doing preparatory teaching for the family,
the most appropriate action for the nurse to take is to:
Advise the family not to bring favorite toys that might be associated with an unpleasant hospital experience.
Encourage the family to bring the child to the hospital a week in advance to tour the hospital.
Explain that the operative site will be covered by a bandage.
Inform the parents that the child may get out of bed when he returns from surgery.
The correct response is “C”. A child of this age may be very concerned about harm to his body,
so it is important to tell him that there will be a bandage on his leg.
The central task for a child this age is to develop a sense of industry and control over his environment.
Having a favorite toy pre- and post-surgery may help relieve the child’s anxiety.
The child should receive a tour of the hospital the night before surgery.
Typically, the child will remain in bed until his vital signs are stable and there is no sign of bleeding from the operative site.
A patient is seen at a weight loss clinic.
She has gained 5 pounds in the last week and reports that she has been eating a diet high in carbohy