Free NCLEX-RN Practice Test #4 – RN Exam Questions & Answers

Increasing abdominal girth is concerning for bowel overdistention and may indicate the development of a postoperative ileus. After a laparoscopic hemicolectomy, sluggish bowel sounds, localized pain and tenderness near the umbilicus, and passage of a small amount of liquid stool can occur during the expected postoperative recovery. Progressive abdominal distention, however, is a finding that requires prompt evaluation because impaired intestinal motility can cause accumulation of gas and intestinal contents.

A newly diagnosed client with diabetes has a priority need for education about the disease, treatment, monitoring, nutrition, medications, and prevention of complications. Therefore, deficient knowledge is the priority nursing diagnosis. Fluid volume deficit, anxiety, and activity intolerance may occur in some clients, but the question provides no findings establishing them as the immediate priority. Education is essential to help the client safely manage diabetes and participate in self-care.

Reinforcing teaching about fall prevention is an important nursing intervention for an elderly client because age-related changes in balance, vision, muscle strength, reaction time, and environmental awareness increase the risk of falls. Hospice teaching is not indicated without evidence of a terminal condition or a need for end-of-life services. A higher-pitched voice can be harder for an older adult with age-related hearing changes to understand, so communication should be clear and appropriately paced rather than simply higher pitched. Fluids should not be generally restricted; although limiting fluids close to bedtime may reduce nocturia, adequate hydration remains important.

Erythromycin is the medication most likely to cause abdominal pain because gastrointestinal adverse effects such as abdominal cramping, nausea, and diarrhea are common with this antibiotic. Norco may cause constipation, nausea, and other opioid-related effects; cetirizine is generally associated with drowsiness or dry mouth; and spironolactone can cause gastrointestinal effects but is not the medication identified in this question as the most likely cause of abdominal pain.

The abdomen should be assessed in the sequence of inspection, auscultation, and palpation. Inspection is performed first to observe contour, distention, scars, movement, and other visible findings. Auscultation must occur before palpation because touching or manipulating the abdomen can alter bowel activity and make assessment of bowel sounds less reliable. Palpation is therefore performed last.

The source rationale identifies answer A as correct: the nurse should acknowledge the wife’s wishes while contacting the appropriate organ-retrieval staff. The situation should be approached sensitively and according to applicable organ-donation procedures rather than arguing with the family or making an abrupt declaration about the disposition of the organs. Answer B is incorrect because the nurse should not simply tell the wife that the hospital has an unrestricted right to take the organs. Answer C is incorrect because telling the wife she is required to donate her husband’s organs is coercive and inappropriate. Answer D is incorrect because avoiding the topic entirely until after death does not appropriately address the family’s concerns or facilitate timely communication with the organ-retrieval team.

The best nursing action is to explore the reason for the client’s lack of motivation. Refusal or inability to participate in self-care may have an underlying physical or psychological cause, such as fatigue, anemia, depression, uncontrolled symptoms, fear, or inadequate understanding. Identifying the cause allows the nurse to individualize interventions. Alternating nurses may reduce continuity and prevent a therapeutic relationship from developing. Simply explaining the need for self-care does not address why the client is refusing, and immediately contacting the physician without first assessing the situation is premature.

The source rationale identifies asking whether the nurse has previously had chickenpox as the initial action. A nurse who has had chickenpox is generally considered immune and therefore is not expected to transmit primary varicella to a susceptible client merely because the nurse’s child has chickenpox. The charge nurse should first determine the nurse’s immunity rather than automatically reassigning the nurse. Asking whether the child’s lesions have crusted does not establish the nurse’s own immune status, and the presence of crusted lesions does not by itself eliminate every relevant exposure concern.

Taking the blood pressure on the side of a mastectomy is the contraindicated action identified by the source. Blood-pressure measurements, venipunctures, and fingersticks are traditionally avoided on the affected side because of concern for lymphatic impairment and lymphedema, particularly when lymph nodes have been removed or radiation has affected lymphatic drainage. Elevating the affected arm can help promote drainage, positioning on the unaffected side can improve comfort and protect the operative area, and using the unaffected side for a fingerstick is appropriate.

Serum creatinine should be assessed before administering gentamicin because gentamicin is an aminoglycoside with important nephrotoxic potential. Renal function influences drug clearance and helps the nurse identify clients at increased risk for accumulation and toxicity. Hematocrit and white blood cell count do not provide the key renal-function assessment needed for this medication. BUN can provide information about renal function, but serum creatinine is the more useful routine indicator for estimating kidney function and guiding aminoglycoside safety.

The source rationale identifies the Western blot as the best indicator for HIV in this question. ELISA is a screening test, whereas a supplemental confirmatory test was traditionally used to establish HIV infection after a reactive screening result. WBC and CBC values are nonspecific and cannot establish an HIV diagnosis. Modern HIV testing algorithms use antigen/antibody and nucleic-acid testing rather than the older Western-blot algorithm, but the answer reflects the terminology and expected answer of the supplied source.

A bull’s-eye rash together with headache and arthralgia is characteristic of Lyme disease, which is transmitted by infected ticks. Therefore, asking whether the client has found any ticks on the body is the most relevant history question among the options because it explores a possible exposure route. Diarrhea, recent international travel, and itching are not as specifically connected with the classic Lyme-disease presentation described in the question.

The elderly client who had a thyroidectomy four days ago is the least-skilled assignment among the choices, assuming the client is stable and has no acute postoperative complication. A nursing assistant can provide appropriate basic care to a stable postoperative client within the assistant’s scope. The clients with cervical-spine fractures, meningitis with fever, and a recent thoracotomy are more clinically unstable and require nursing assessment and monitoring by licensed nursing staff.

For hyphema, blood is present in the anterior chamber of the eye, usually after ocular trauma. The appropriate intervention identified by the source is to elevate the head of the bed and apply ice to the eye. Elevation helps reduce pressure and bleeding-related complications, while a cold application can help limit swelling. The other interventions do not address the ocular hemorrhage and are unrelated to the immediate management of hyphema.

Ferrous sulfate is absorbed more effectively when administered with a source of vitamin C, such as orange juice. Vitamin C promotes iron absorption, making orange juice the best choice. Milk and calcium-containing foods can reduce iron absorption, and taking iron with meals may decrease absorption even though food can sometimes be used to reduce gastrointestinal upset. The medication should not be administered simply as an undiluted preparation when the goal is to optimize absorption.

A client with an ileostomy should be taught to use an appropriate skin barrier such as Stomahesive to protect the peristomal skin from the irritating liquid intestinal output. Ileostomy output is typically liquid or semiliquid and contains digestive enzymes, making meticulous skin protection important. Routine irrigation is not required for an ileostomy, and stool softeners are generally unnecessary because the output is already liquid. Karaya powder is not the recommended choice in the supplied rationale for obtaining an effective pouch seal.

Phytonadione, or vitamin K, is administered to newborns to facilitate normal blood clotting. Newborns have relatively low vitamin K stores and limited intestinal bacterial production immediately after birth, which can increase the risk of vitamin K deficiency bleeding. Vitamin K supports synthesis of several clotting factors. It is not administered primarily to treat infection, replace electrolytes, or simply stop an active hemorrhage.

Hemabate (carboprost tromethamine) is a uterotonic prostaglandin used to treat postpartum hemorrhage related to uterine atony when bleeding is not adequately controlled by other measures. The presentation of heavy lochia rubra, uterine enlargement, and excessive clots is consistent with significant postpartum bleeding. Fentanyl and butorphanol are analgesics, while dinoprostone is a prostaglandin used primarily for cervical ripening rather than the treatment identified in this question.

An antiemetic should be administered before chemotherapy when indicated because many chemotherapeutic agents can trigger significant nausea and vomiting. Preventive antiemetic therapy can reduce symptoms before they become severe and can help the client tolerate treatment. A routine IV-fluid bolus, pain medication, or allowing the client to eat is not the priority intervention described by the source and should instead be based on the individual treatment plan and clinical condition.

Pitocin (oxytocin) is effective when it produces adequate uterine contraction, resulting in a firm, well-contracted fundus in the midline and helping reduce postpartum bleeding. A uterus that is boggy indicates poor uterine tone and increases hemorrhage risk. A fundus deviated to the left commonly suggests a distended bladder rather than effective uterine contraction. Oxytocin promotes uterine contraction; it does not directly correct uterine deviation caused by bladder distention.

Secondary syphilis can produce a diffuse rash that characteristically includes the palms of the hands and soles of the feet, often accompanied by systemic flu-like symptoms. This stage occurs after the primary lesion and reflects disseminated infection. Chancres are associated with primary syphilis, while findings such as neurologic deterioration and gummatous lesions are associated with later tertiary disease. Therefore, the ‘copper penny’ rash described in the source is the expected finding for secondary syphilis.

Creon (pancrelipase) is a pancreatic enzyme replacement medication used to assist digestion in clients who have inadequate pancreatic enzyme production, including many clients with cystic fibrosis. The enzymes help digest fats, proteins, and carbohydrates so nutrients can be absorbed more effectively. Creon does not thin respiratory secretions, promote clotting, or shrink nasal polyps. Its therapeutic purpose is replacement of digestive enzymes.

Zoloft (sertraline) is a selective serotonin reuptake inhibitor (SSRI). Linezolid (Zyvox) has monoamine oxidase-inhibiting activity, so concurrent use with serotonergic antidepressants can increase the risk of serotonin syndrome. The syndrome can include agitation, confusion, sweating, tremor, hyperreflexia, fever, and other neuromuscular or autonomic abnormalities. Nexium, Lipitor, and Zyrtec are not the medications identified by the source as creating this serotonergic interaction.

When mixing regular insulin with NPH insulin, regular insulin should be drawn into the syringe before NPH insulin. This follows the ‘clear before cloudy’ principle and helps prevent contamination of the regular-insulin vial with NPH insulin. The two insulins can be mixed when prescribed and compatible, so two separate injections are not automatically required. It does matter which insulin is drawn up first, making the statements that order does not matter or that NPH should be drawn first incorrect.

Before a cardiac CTA with contrast, the source directs the nurse to assess for a history of allergy to shellfish or iodine. This reflects the traditional teaching associated with iodinated contrast assessment in the supplied material. The client’s ability to lie prone is not the relevant screening issue, and a history of reaction to nitrates or the presence of tattoos does not address the contrast-related concern identified by the source. In current practice, the key assessment is specifically a history of prior reaction to iodinated contrast, rather than a shellfish allergy itself.

Methergine (methylergonovine) is a uterotonic medication that produces sustained uterine contraction and is used to manage postpartum bleeding when uterine atony is not controlled adequately with oxytocin. The medication helps the uterus contract and reduces blood loss. Phytonadione is vitamin K, aminocaproic acid has different hemostatic indications, and betamethasone is a corticosteroid used in obstetric contexts such as fetal lung maturation rather than routine treatment of postpartum uterine atony.

A client who receives a transplanted organ generally requires immunosuppressive therapy for life to reduce the risk of immune-mediated rejection. The transplanted organ remains foreign to the recipient’s immune system, so stopping immunosuppression can permit rejection. The duration is therefore not limited to one, five, or ten years under the framework of the source question. Medication regimens and doses may change over time, but ongoing immunosuppression is generally required.

Cullen’s sign is a bluish or ecchymotic discoloration around the umbilicus associated with intra-abdominal or retroperitoneal bleeding. In a client with multiple injuries, this finding raises concern for damage to abdominal organs and internal hemorrhage. It is not a finding that specifically indicates injury to the frontal lobe, lungs, or spinal cord. The sign therefore supports concern for abdominal injury in the context presented.

Regular insulin is short-acting insulin and, according to the source, begins to exert an effect within approximately 30–60 minutes after subcutaneous administration. This timing is important when coordinating insulin administration with meals and monitoring for hypoglycemia. The other intervals are not the onset range identified in the supplied rationale. The exact pharmacokinetic profile can vary with route and formulation, but the source’s expected answer is 30–60 minutes.

The statement indicating a need for further teaching is ‘I often skip dinner because I don’t feel hungry.’ Glyburide is a sulfonylurea that stimulates insulin release and can cause hypoglycemia, particularly when food intake is inadequate. Skipping meals therefore increases the risk of low blood glucose. Carrying a source of rapidly absorbed carbohydrate and wearing medical identification are appropriate safety measures. The source also identifies sun avoidance as appropriate teaching, so the problematic statement is the one about routinely skipping dinner.