NCLEX Daily Practical Exercise 55

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6. A 62-year-old client arrives at a community health fair where the nurse is offering blood pressure screenings. Upon assessment, the nurse notes that the client’s blood pressure is 160/96 mmHg. The client claims that their blood pressure is “usually much lower” and they recently started new medication for arthritis. What would the nurse advise the client to do?

A. Go get a blood pressure check within the next 15 minutes

B. Check blood pressure again in two (2) months

C. See the healthcare provider immediately

D. Visit the health care provider within one (1) week for a BP check

Correct Answer: A

Answer Explanation:

The blood pressure reading is moderately high with the need to have it rechecked after a few minutes to verify. The client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke.

Options B & D: Waiting 2 months or a week for follow-up is too long.
Option C: Immediate check by the provider of care is not warranted.

7. It’s a busy evening shift, and the hospital has just sounded an alarm for a disaster drill. The unit manager informs the nurse that they need to make room for potential mass casualty admissions. The nurse is given four clients and must decide who to prioritize for discharge to accommodate new admissions. Who should be considered FIRST for discharge?

A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and admitted with bacterial pneumonia five days ago.

B. A young adult with diabetes mellitus Type 2 for over ten (10) years and admitted with antibiotic-induced diarrhea 24 hours ago.

C. An elderly client with a history of hypertension, hypercholesterolemia, and lupus, and was admitted with Stevens-Johnson syndrome that morning.

D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago.

Correct Answer: A

Answer Explanation:

The best candidate for discharge is one who has had a chronic condition and is most familiar with their care. This client in option A is most likely stable and could continue medication therapy at home.

Option B: The client with antibiotic-induced diarrhea still needs continuous strict monitoring as the blood sugar levels may become unstable and dehydration is still possible.
Option C: Stevens-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters.
Option D: Cellulitis is often an underestimated complication of HIV disease, but they are responsible for an appreciable morbidity.

8. A 25-year-old male is seen in the endocrinology clinic for unexplained fatigue, weight gain, and low energy levels. After a series of diagnostic tests, he is diagnosed with hypothyroidism. The healthcare provider prescribes levothyroxine (Synthroid) 50 mcg/day by mouth. As the nurse educates the client about this medication, which point should be emphasized?

A. Should be taken in the morning

B. May decrease the client’s energy level

C. Must be stored in a dark container

D. Will decrease the client’s heart rate

Correct Answer: A

Answer Explanation:

Option A: Levothyroxine (Synthroid) has a side effect of insomnia. Taking it in the morning could prevent interfering with the client’s sleeping pattern.
Option B: Some of the side effects of Levothyroxine include hyperactivity and an increase in heart rate.
Option C: Keep this drug in a cool, dark, and dry place.
Option D: A decrease in the heart rate is the desired effect of Levothyroxine.

9. A 3-year-old child was brought to the pediatric clinic after the sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning forward, tongue protruding, drooling, and suprasternal retractions. What should the nurse do first?

A. Prepare the child for X-ray of upper airways

B. Examine the child’s throat

C. Collect a sputum specimen

D. Notify the healthcare provider of the child’s status

Correct Answer: D

Answer Explanation:

These findings suggest a medical emergency and may be due to epiglottitis. Any child with an acute onset of an inflammatory response in the mouth and throat should receive immediate care.

Option A: If epiglottitis is seriously considered, no imaging studies are required. In less-clear cases, imaging studies are occasionally helpful in establishing the diagnosis or excluding epiglottitis.
Option B: Examining the child’s throat should not be attempted because it may compromise respiratory effort.
Option C: There are no indications for the collection of sputum specimens.

10. A school nurse is assessing 8-year-old Timmy, who was brought to the school health office by his teacher due to concerns about his recent behavior. The teacher reports that Timmy has been asking to go to the bathroom frequently during class, appears tired, and has been caught sneaking snacks during lessons. Upon further questioning, Timmy’s mother, who was called to the school, mentions that he has been drinking more water than usual at home, has an increased appetite, and has had a few episodes of bedwetting in the past month. She also notes that despite eating more, he seems to have lost some weight. Given these observations and suspecting diabetes, which symptom is most likely to prompt parents to seek medical evaluation for their school-age child?

A. Polyphagia

B. Dehydration

C. Bedwetting

D. Weight loss

Correct Answer: C

Answer Explanation:

While all of the symptoms listed can be indicative of diabetes mellitus, bedwetting in a school-age child who previously had control over their bladder is often the most alarming symptom for parents. It represents a regression in a previously acquired skill and can be distressing for both the child and the parents. This symptom, combined with the other signs, would likely prompt parents to seek medical evaluation.

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