NCLEX RN Free Practice Questions

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A 71-year-old client fell and injured her left leg while cooking in the kitchen. Her husband calls the ambulance, and she is taken to the emergency department at a local hospital. X-ray reports confirm that she has an intertrochanteric fracture of the left femur. Her left leg will require skeletal traction initially and then surgery. The nurse knows that this type of traction will be used:

  • A. By inserting pins to provide steady pull on the bone
  • B. To suspend the leg in a sling without pull on the extremity
  • C. Intermittently to place a pull over the pelvis and lower spine
  • D. With weights at both ends of the bed to maintain pull on the upper extremity
Correct Answer: A

Rationale: Skeletal traction is the application of traction directly to bone with the use of pins and wires or tongs for the purpose of providing a strong, steady, continuous longitudinal pull on the bone. It is indicated for preoperative immobilization and positioning of hip and femur fractures. A type of skeletal traction (balanced suspension with a Thomas splint and Pearson attachment) uses a sling to support the extremity, but it also uses weights to provide a strong, steady continuous pull on the extremity. A sling is used instead of pins. Pelvic traction provides an intermittent pull over the pelvis and bone, whereas skeletal traction is continuous. Pelvic traction does not use pins. Skeletal traction uses weights at the end of the bed to provide a continuous pull on long bones. Weights are not applied to both ends of the bed.

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A 27-year-old primigravida at 32 weeks' gestation has been diagnosed with complete placenta previa. Conservative management including bed rest is the proper medical management. The goal for fetal survival is based on fetal lung maturity. The test used to determine fetal lung maturity is:

  • A. Dinitrophenylhydrazine
  • B. Metachromatic stain
  • C. Blood serum phenylalanine test
  • D. Lecithin-sphingomyelin ratio
Correct Answer: D

Rationale: Dinitrophenylhydrazine is a laboratory test used to detect phenylketonuria, maple syrup urine disease, and Lowe's syndrome. Metachromatic stain is a laboratory test that may be used to diagnose Tay-Sachs and other lipid diseases of the central nervous system. The blood serum phenylalanine test is diagnostic of phenylketonuria and can be used for wide-scale screening. A lecithin-sphingomyelin ratio of at least 2:1 is indicative of fetal lung maturity, and survival of the fetus is likely.

Diabetes during pregnancy requires tight metabolic control of glucose levels to prevent perinatal mortality. When evaluating the pregnant client, the nurse knows the recommended serum glucose range during pregnancy is:

  • A. 70 mg/dL and 120 mg/dL
  • B. 100 mg/dL and 200 mg/dL
  • C. 40 mg/dL and 130 mg/dL
  • D. 90 mg/dL and 200 mg/dL
Correct Answer: A

Rationale: The recommended range is 70-120 mg/dL to reduce the risk of perinatal mortality. (B, C, D) These levels are not recommended. The higher the blood glucose, the worse the prognosis for the fetus. Hypoglycemia can also have detrimental effects on the fetus.

A client has recently been diagnosed with primary open-angle glaucoma. The nurse should tell the client to avoid taking:

  • A. Aleve (naprosyn)
  • B. Benadryl (diphenhydramine)
  • C. Tylenol (acetaminophen)
  • D. Robitussin (guaifenesin)
Correct Answer: B

Rationale: Benadryl, an antihistamine, can increase intraocular pressure, worsening primary open-angle glaucoma, so it should be avoided.

The client is diagnosed with hyperkalemia. Which food should the nurse instruct the client to avoid?

  • A. Bananas
  • B. Broccoli
  • C. Salmon
  • D. Pasta
Correct Answer: A

Rationale: Bananas are high in potassium, which should be avoided in hyperkalemia to prevent worsening arrhythmias. Broccoli, salmon, and pasta have lower potassium content.

When assessing a child with diabetes insipidus, the nurse should be aware of the cardinal signs of:

  • A. Anemia and vomiting
  • B. Polyuria and polydipsia
  • C. Irritability relieved by feeding formula
  • D. Hypothermia and azotemia
Correct Answer: B

Rationale: Anemia and vomiting are not cardinal signs of diabetes insipidus. Polyuria and polydipsia are the cardinal signs of diabetes insipidus. Irritability relieved by feeding water, not formula, is a common sign, but not the cardinal sign, of diabetes insipidus. Hypothermia and azotemia are signs, but not cardinal signs, of diabetes insipidus.

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