NCLEX Daily Practical Exercise 19

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6. A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform?

A. Ask the patient to lie down on the exam table.

B. Draw blood for chemistry panel and arterial blood gas (ABG).

C. Send the patient for a chest x-ray.

D. Check blood pressure.

Correct Answer: D

Answer Explanation:

A patient with congestive heart failure and dyspnea may have pulmonary edema, which can cause severe hypertension. Therefore, taking the patient’s blood pressure should be the first action.

Option A: Lying flat on the exam table would likely worsen the dyspnea, and the patient may not tolerate it.
Option B: Blood draws for chemistry and ABG will be required, but not prior to the blood pressure assessment.
Option C: A chest X-ray may be ordered by the physician after priority nursing care.

7. A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse complaining of frequent headaches. Which of the following responses to the patient is correct?

A. “Stop taking the nitroglycerin and see if the headaches improve.”

B. “Go to the emergency department to be checked because nitroglycerin can cause bleeding in the brain.”

C. “Headaches are a frequent side effect of nitroglycerine because it causes vasodilation.”

D. “The headaches are unlikely to be related to the nitroglycerin, so you should see your doctor for further investigation.”

Correct Answer: C

Answer Explanation:

Nitroglycerin is a potent vasodilator and often produces unwanted effects such as headache, dizziness, and hypotension. Patients should be counseled, and the dose titrated, to minimize these effects. In spite of the side effects, nitroglycerin is effective at reducing myocardial oxygen consumption and increasing blood flow.

Option A: The patient should not stop the medication.
Option B: Nitroglycerine does not cause bleeding in the brain.
Option D: Headaches are one of the side effects of nitroglycerin.

8. A patient received surgery and chemotherapy for colon cancer, completing therapy three (3) months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations would account for her symptoms?

A. The symptoms may be the result of anemia caused by chemotherapy.

B. The patient may be immunosuppressed.

C. The patient may be depressed.

D. The patient may be dehydrated.

Correct Answer: A

Answer Explanation:

Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects, which often includes anemia because of bone-marrow suppression.

Option B: There is no evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of immunosuppression.
Options C and D: The information given does not indicate that depression or dehydration is a cause of her symptoms.

9. A clinic patient has a hemoglobin concentration of 10.8 g/dL and reports sticking to a strict vegetarian diet. Which of the following nutritional advice is appropriate?

A. The diet is providing adequate sources of iron and requires no changes.

B. The patient should add meat to her diet; a vegetarian diet is not advised.

C. The patient should use iron cookware to prepare foods, such as dark-green, leafy vegetables, and legumes, which are high in iron.

D. A cup of coffee or tea should be added to every meal

Correct Answer: C

Answer Explanation:

Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly anemic. When food is prepared in iron cookware its iron content is increased.

Option A: In addition, dark green leafy vegetables, such as spinach and kale, and legumes are high in iron.
Option B: Mild anemia does not require that animal sources of iron be added to the diet. Many non-animal sources are available.
Option D: Coffee and tea increase gastrointestinal activity and inhibit the absorption of iron.

10. A hospitalized patient is receiving packed red blood cells (PRBCs) for treatment of severe anemia. Which of the following is the most accurate statement?

A. Transfusion reaction is most likely immediately after the infusion is completed.

B. PRBCs are best infused slowly through a 20g. IV catheter.

C. PRBCs should be flushed with a 5% dextrose solution.

D. A nurse should remain in the room during the first 15 minutes of infusion.

Correct Answer: D

Answer Explanation:

Transfusion reaction is most likely during the first 15 minutes of infusion, and a nurse should be present during this period.

Option A: Transfusion reaction most likely occurs during the first 15 minutes, not after the infusion has been completed.
Option B: PRBCs should be infused through a 19g or larger IV catheter to avoid slow flow, which can cause clotting.
Option C: PRBCs must be flushed with 0.45% normal saline solution. Other intravenous solutions will hemolyze the cells.

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