Welcome to our NCLEX Daily Ten Practice! This practice is designed to help you solidify your knowledge, improve your skills, and prepare thoroughly for the NCLEX exam. With ten questions to tackle each day, you’ll have the opportunity to review a broad range of subjects covered in the NCLEX exam.
1. A client is admitted to the hospital with benign prostatic hyperplasia, the nurse most relevant assessment would be:
Correct Answer: B
This indicates that the bladder is distended with urine, therefore palpable. In the elective setting, the examination should include abdominal examination (looking for a palpable bladder/loin pain) and examination of external genitalia (meatal stenosis or phimosis). Benign prostatic hyperplasia (BPH) refers to the nonmalignant growth or hyperplasia of prostate tissue and is a common cause of lower urinary tract symptoms in men.
Option A: Flank pain is a vague symptom associated with urinary system infections. Lower urinary tract symptoms can be divided into storage (frequency, nocturia, urgency) and voiding symptoms (stream, straining, hesitancy, prolonged micturition) and can help establish other causes of urinary symptoms such as urinary tract infections/overactive bladder, in addition to determining the site affected (bladder vs. prostate).
Option C: BPH only occurs in older men. Disease prevalence has been shown to increase with advancing age. Indeed the histological prevalence of BPH at autopsy is as high as 50% to 60% for males in their 60’s, increasing to 80% to 90% of those over 70 years of age.
Option D: Urethral discharge is not a manifestation of BPH. Men with BPH are likely to report predominant symptoms of nocturia, poor stream, hesitancy, or prolonged micturition. The examination should then conclude with a digital rectal examination making a note in particular of the size, shape (how many lobes), and consistency (smooth/hard/nodular) of the prostate (BPH is characterized by a smooth enlarged prostate).
2. A client has undergone a penile implant. After 24 hrs of surgery, the client’s scrotum was edematous and painful. The nurse should:
Correct Answer: C
Elevation increases lymphatic drainage, reducing edema and pain. The penis should then be placed upward on the lower abdomen, to limit any downward curvature of this penis postoperatively. Scrotal support or tight mesh underwear may be used after the sterile dressing is removed.
Option A: Several warm baths per day, beginning on the third day after the procedure, would reduce the swelling. Most patients will stay in the hospital overnight following prosthesis placement. This allows for proper guidance on post-operative instructions, as well as the ability to remove the foley catheter without an additional visit to the outpatient clinic.
Option B: Warm baths, instead of soaks, are recommended after three days post surgery. After the penile implant procedure, it is common for bruises and swelling of the scrotum to occur. With several warm baths per day, beginning on the third day after the penile procedure, swelling slowly disappears over a 7 to 14 day period. As healing occurs and swelling disappears, the pain will gradually subside.
Option D: Edema and pain are normal manifestations 24 hours after the surgery. A short course of narcotic pain medication may be warranted. The patient is instructed to avoid any heavy lifting until the follow-up visit in 7-14 days. A drain may be placed if the patient is scheduled to stay in the hospital overnight. The drain may be removed on postoperative day number one at the same time as foley catheter removal.
3. Nurse Hazel receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?
Correct Answer: B
Detection of myoglobin is a diagnostic tool to determine whether myocardial damage has occurred. Myoglobin, an oxygen-carrying protein found in cardiac muscle and striated skeletal muscle, presents an attractive alternative to CPK and LDH in the emergency department setting for identification of acute myocardial infarction. Myoglobin levels may be elevated in the serum within one hour after myocardial cell death with peak levels reached within four to six hours.
Option A: Liver disease usually has elevated hepatic enzymes, elevated serum bilirubin, elevated serum ammonia, low levels of glucose, and elevated creatinine, among others. In chronic liver disease, there is inflammation and destruction of hepatocytes that leads to the release of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), hence the high levels of these markers in the blood. Other parameters (ALP and GGT) of LFTs also appear elevated in cholestatic conditions like PBC.
Option C: Initial laboratory tests for hypertension may include urinalysis; fasting blood glucose; hematocrit; serum sodium, potassium, creatinine, and calcium; and lipid profile. The evaluation consists of looking for signs of end-organ damage and consists of the following: blood workup including complete blood count, ESR, creatinine, eGFR, electrolytes, HbA1c, thyroid profile, blood cholesterol levels, and serum uric acid; 12 lead ECG (to document left ventricular hypertrophy, cardiac rate, and rhythm); and urine albumin to creatinine ratio.
Option D: Cancer is diagnosed based on a number of diagnostic tests and procedures and radiology. The 2015 NHIS findings show that the utilization of cancer screening tests for cervical, colorectal, and breast cancer was below Healthy People 2020 target. In 2015, rates for Pap tests, mammography, colorectal cancer screening were 80%, 70%, and just above 60 %, respectively, whereas the HP 2020 targets are 93% for Pap tests, 81% for mammography, and 70.5 % for colorectal cancer screening.
4. Nurse Maureen would expect a client with mitral stenosis would demonstrate symptoms associated with congestion in the:
Correct Answer: D
When mitral stenosis is present, the left atrium has difficulty emptying its contents into the left ventricle because there is no valve to prevent backward flow into the pulmonary vein, the pulmonary circulation is under pressure. Mitral valve areas less than 2 square centimeters causes an impediment to the blood flow from the left atrium into the left ventricle. This creates a pressure gradient across the mitral valve. As the gradient across the mitral valve increases, the left ventricle requires the atrial kick to fill with blood.
Option A: In mitral stenosis, the left atrium is the one which has difficulty in emptying its content, not the right atrium. Mitral valve area less than 1 square centimeter causes an increase in left atrial pressure. The normal left ventricular diastolic pressure is 5 mmHg. A pressure gradient across the mitral valve of 20 mmHg due to severe mitral stenosis will cause a left atrial pressure of about 25 mmHg. This left atrial pressure is transmitted to the pulmonary vasculature resulting in pulmonary hypertension.
Option B: Superior vena cava (SVC) syndrome is a collection of clinical signs and symptoms resulting from either partial or complete obstruction of blood flow through the SVC. This obstruction is most commonly a result of thrombus formation or tumor infiltration of the vessel wall. The most common signs and symptoms include face or neck swelling, upper extremity swelling, dyspnea, cough, and dilated chest vein collaterals.
Option C: Aortic regurgitation is a condition in which the aortic valve does not close properly, allowing blood to leak from the aorta back into the heart’s left ventricle. This leakage increases the left ventricle’s volume load, causing it to dilate and eventually fail – leading to pulmonary (lung) congestion.
5. A client has been diagnosed with hypertension. The nurse priority nursing diagnosis would be:
Correct Answer: A
Managing hypertension is the priority for the client with hypertension. Clients with hypertension frequently do not experience pain, deficient volume, or impaired skin integrity. It is the asymptomatic nature of hypertension that makes it so difficult to treat. Monitor and record BP. Measure both arms and thighs three times, 3–5 min apart while the patient is at rest, then sitting, then standing for initial evaluation. Use correct cuff size and accurate technique.
Option B: Impaired skin integrity is an inappropriate nursing diagnosis because there is no alteration in the skin in hypertension. Comparison of pressures provides a more complete picture of vascular involvement or scope of problem. Severe hypertension is classified in the adult as a diastolic pressure elevation to 110 mmHg; progressive diastolic readings above 120 mmHg are considered first accelerated, then malignant (very severe). Systolic hypertension also is an established risk factor for cerebrovascular disease and ischemic heart disease, when diastolic pressure is elevated.
Option C: The client with hypertension experiences no fluid deficit. Note presence, quality of central and peripheral pulses. Bounding carotid, jugular, radial, and femoral pulses may be observed and palpated. Pulses in the legs and feet may be diminished, reflecting effects of vasoconstriction (increased systemic vascular resistance [SVR]) and venous congestion.
Option D: There is no pain experienced in hypertension. Auscultate heart tones and breath sounds. S4 heart sound is common in severely hypertensive patients because of the presence of atrial hypertrophy (increased atrial volume and pressure). Development of S3 indicates ventricular hypertrophy and impaired functioning. Presence of crackles, wheezes may indicate pulmonary congestion secondary to developing or chronic heart failure.