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PRACTICE QUESTIONS

Monday, 13 July 2015

PRACTICE QUESTIONS PART =6 ANSWERS AND RATIONALES


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Answers and Rationales 




1.  Answer  D is correct.  

It  is  important  to  assess  the  extremities  for  blood  vessel  occlusion  in the  client  with  sickle  cell  anemia  because  a  change  in  capillary  refill  would  indicate  a  change in  circulation.  Body  temperature,  motion,  and  sensation  would  not  give  informa-tion regarding peripheral circulation; therefore, answers A, B, and C are incorrect.  






2.  Answer  D  is  correct.  Placing  the  client  in  semi-Fowler’s  position  provides  the  best oxygenation  for  this  client.  Flexion  of  the  hips  and  knees,  which  includes  the  kneechest  position,  impedes  circulation  and  is  not  correct  positioning  for  this  client.   Therefore, answers A, B, and C are incorrect.  




3.  Answer B is  correct. 

 It  is  important  to  keep  the  client  in  sickle  cell  crisis hydrated  to  prevent  further  sickling  of  the  blood.  Answer A  is  incorrect because  a  mechanical  cuff  places  too  much  pressure  on  the  arm.  Answer C is  incorrect  because  raising  the  knee  gatch  impedes  circulation.  Answer D is incorrect because Tylenol is too mild an anal-gesic for the client in crisis.  





4.  Answer C is  correct.  Hydration  is  important  in  the  client  with  sickle  cell disease  to  prevent  thrombus  formation.  Popsicles,  gelatin,  juice,  and pudding  have  high  fluid  content.  The  foods  in  answers  A,  B,  and  D do  not aid in hydration and are, therefore, incorrect. 






 5.  Answer C is  correct.  

The  pulse  oximetry  indicates  that  oxygen  levels  are low;  thus,  oxygenation  takes  precedence  over pain  relief.  Answer A  is incorrect  because  although  a  warm  environment  reduces  pain  and  minimizes sickling,  it  would  not  be  a  priority.  Answer B  is  incorrect  because  although hydration  is  important,  it  would  not  require  a  bolus.  Answer D is  incorrect because Demerol is acidifying to the blood and increases sickling.  




6.  Answer  C  is  correct.  

Egg  yolks,  wheat  bread,  carrots,  raisins,  and  green,  leafy vegeta-bles  are  all  high  in  iron,  which  is  an  important  mineral  for  this  client.  Roast beef,  cab-bage,  and  pork  chops  are  also  high  in  iron,  but  the  side  dishes accompanying these choices are not; therefore, answers A, B, and D are incorrect.  




7.  Answer D is  correct.  

Taking  a  trip  to  the  museum  is  the  only  answer that does  not  pose  a  threat.  A  family  vacation  in  the  Rocky  Mountains  at  high altitudes,  cold  temper-atures,  and  airplane  travel  can  cause  sickling  episodes and should be avoided; there-fore, answers A, B, and C are incorrect. 

 



8.  Answer D is  correct. 

 The  tongue  of  the  client  with  B12  insufficiency  is  red and  beefy.  A,  B,  and  C  incorrect  because  enlarged  spleen,  elevated  BP, and bradycardia are not associated with B12 deficiency. 



 

9.  Answer  C  is  correct. 

 The  oral  mucosa  and  hard  palate  (roof  of  the  mouth)  are the  best  indicators  of  jaundice  in  dark-skinned  persons.  The  conjunctiva  can  have normal  deposits  of  fat,  which  give  a  yellowish  hue;  thus,  answer  A  is  incorrect. The  soles  of  the  feet  can  be  yellow  if  they  are  calloused,  making  answer  B incorrect;  the  shins  would  be  an  area  of  darker  pigment,  so  answer  D  is  incorrect.   





10.  Answer  B  is  correct.  When  there  are  fewer  red  blood  cells,  there  is  less  hemoglobin and  less  oxygen.  Therefore,  the  client  is  often  short  of  breath,  as  indicated  in  answer B.  The  client  with  anemia  is  often  pale  in  color,  has  weight  loss,  and  may  be  hypotensive. Answers A, C, and D are within normal and, therefore, are incorrect.  




11.  Answer  A is  correct.  

The  client  with  polycythemia  vera  is  at  risk  for  thrombus  formation.  Hydrating  the  client  with  at  least  3L  of  fluid  per  day  is  important  in  preventing  clot formation,  so  the  statement  to  drink  less  than  500mL  is  incorrect.  Answers  B,  C,  and D are  incorrect  because  they  all  contribute  to  the  prevention  of  complications.  Support hose  promotes  venous  return,  the  electric  razor  prevents  bleeding  due  to  injury,  and  a diet low in iron is essential to preventing further red cell formation. 

 




12.  Answer C is  correct.  Radiation  treatment  for  other  types  of  cancer  can contribute  to  the  development  of  leukemia.  Some  hobbies  and  occupations involving  chemicals  are  linked  to  leukemia,  but  not  the  ones  in  these answers;  therefore,  answers  A  and  B  are  incorrect.  Answer D is  incorrect because the incidence of leukemia is higher in twins not siblings.  




13.  Answer D is  correct.  Petechiae  are  not  usually  visualized  on  dark  skin. The  soles  of  the  feet  and  palms  of  the  hand  provide  a  lighter  surface  for assessing  the  client  for petichiae.  Answers  A,  B,  and  C are  incorrect because the skin may be too dark to make an assessment. 

 




14.  Answer B is  correct.  

The  client  with  leukemia  is  at  risk  for infection  and  has often  had  recurrent  respiratory  infections  during  the  previous  6  months. Insomnolence,  weight  loss,  and  a  decrease  in  alertness  also  occur in leukemia,  but  bleeding  tendencies  and  infections  are  the  primary  clinical manifestations; therefore, answers A, C, and D are incorrect.  




15.  Answer  B  is  correct.  

The  client  with  acute  leukemia  has  bleeding  tendencies due  to  decreased  platelet  counts,  and  any  injury  would  exacerbate  the  problem. The  client  would  require  close  monitoring  for  hemorrhage,  which  is  of  higher priority than the diagnoses in answers A, C, and D, which are incorrect.  




16.  Answer A  is  correct.  Radiation  therapy  often  causes  sterility  in  male  clients and  would  be  of  primary  importance  to  this  client.  The  psychosocial  needs  of the  client  are  important  to  address  in  light  of  the  age  and  life  choices. Hodgkin’s  disease,  however,  has  a  good  prognosis  when  diagnosed  early. Answers B, C, and D are incorrect because they are of lesser priority.  






17.  Answer  A is  correct.  Clients  with  autoimmune  thrombocytopenic  purpura  (ATP)  have low  platelet  counts,  making  answer  A  the  correct  answer.  White  cell  counts,  potassium levels, and PTT are not affected in ATP; thus, answers B, C, and D are incorrect.  




18.  Answer  A is  correct. 

 The  normal  platelet  count  is  120,000–400,000.  Bleeding occurs  in  clients  with  low  platelets.  The  priority  is  to  prevent  and  minimize bleeding.  Oxygenation  in  answer  C  is  important,  but  platelets  do  not  carry oxygen. Answers B and D are of lesser priority and are incorrect in this instance.  





19.  Answer  C  is  correct. 

 A  prolactinoma  is  a  type  of  pituitary  tumor.  Elevating  the head  of  the  bed  30°  avoids  pressure  on  the  sella  turcica  and  helps  to  prevent headaches.  Answers  A,  B,  and  D  are  incorrect  because  Trendelenburg,  Valsalva maneuver,  and  coughing  all  increase  the  intracranial  pressure.   





20.  Answer B is correct.  

The  large  amount  of  fluid  loss  can  cause  fluid  and electrolyte  imbal-ance  that  should  be  corrected.  The  loss  of  electrolytes  would  be reflected  in  the  vital  signs.  Measuring  the  urinary  output  is  important,  but  the stem already  says  that  the  client  has  polyuria,  so  answer  A  is  incorrect. Encouraging  fluid  intake  will  not  correct  the  prob-lem,  making  answer  C  incorrect. Answer D is incorrect because weighing the client is not necessary at this time.  




21. Answer  C  is  correct.  

C  is  correct  because  direct  pressure  to  the  nose  stops  the bleed-ing. Answers A, B, and D are incorrect because they do not stop bleeding 

 



22.Answer A is correct.  



Blood  pressure  is  the  best  indicator  of  cardiovascular collapse  in  the  client  who  has  had  an  adrenal  gland  removed.  The  remaining gland  might  have  been  sup-pressed  due  to  the  tumor  activity.  Temperature  would be  an  indicator  of  infection,  decreased  output  would  be  a  clinical  manifestation  but would  take  longer  to  occur  than  blood  pressure  changes,  and  specific  gravity changes occur with other disorders; there-fore, answers B, C, and D are incorrect.  





 23.Answer  A is correct.  

IV  glucocorticoids  raise  the  glucose  levels  and  often  require  coverage  with  insulin.  Answer  B  is  not  necessary  at  this  time,  sodium  and  potassium  levels  would  be  monitored  when  the  client  is  receiving  mineral  corticoids,  and  daily weights is unnecessary; therefore, answers B, C, and D are incorrect.  



24. Answer B is correct.  The  parathyroid  glands  are  responsible  for  calcium  production and  can  be  damaged  during  a  thyroidectomy.  The  tingling  can  be  due  to  low  calcium levels.  The  crash  cart  would  be  needed  in  respiratory  distress  but  would  not  be  the next  action  to  take;  thus,  answer  A  is  incorrect.  Hypertension  occurs  in  thyroid  storm and the drainage would occur in hemorrhage, so answers C and D are incorrect. 



 


25. Answer  D  is  correct. 

 The  decrease  in  pulse  can  affect  the  cardiac  output and  lead  to  shock,  which  would  take  precedence  over  the  other  choices; therefore, answers A, B, and C are incorrect. 

 


26.  Answer A is correct. 

 The  client  taking  antilipidemics  should  be  encouraged  to report  muscle  weakness  because  this  is  a  sign  of  rhabdomyolysis.  The medication takes effect within 1 month of beginning therapy, so answer B is  incorrect.  The  medication  should  be  taken  with  water because  fruit  juice, particularly  grapefruit,  can  decrease  the  effectiveness,  making  answer C incorrect.  Liver function  studies  should  be  checked  before  beginning  the medication, not after the fact, making answer D incorrect.

 



 27.Answer B is correct.  Hyperstat  is  given  IV  push  for  hypertensive  crises,  but  it  often causes  hyperglycemia.  The  glucose  level  will  drop  rapidly  when  stopped.  Answer  A  is incorrect  because  the  hyperstat  is  given  by  IV  push.  The  client  should  be  placed  in dorsal  recumbent  position,  not  Trendelenburg  position,  as  stated  in  answer  C.  Answer D is incorrect because the medication does not have to be covered with foil. 




28.  Answer C is  correct. 

 A heart  rate  of  60  in  the  baby  should  be  reported immediately.  The  dose  should  be  held  if  the  heart  rate  is  below  100bpm. The  blood  glucose,  blood  pressure,  and  respirations  are  within  normal limits;  thus  answers  A,  B,  and  D are  incorrect.   



29.Answer  C  is  correct.  Nitroglycerine  should  be  kept  in  a  brown  bottle  (or  even  a  special  air-  and  water-tight,  solid  or  plated  silver  or  gold  container)  because  of  its  instability  and  tendency  to  become  less  potent  when  exposed  to  air,  light,  or  water.  The  supply  should  be  replenished  every  6  months,  not  3  months,  and  one  tablet  should  be taken  every  5  minutes  until  pain  subsides,  so  answers  A  and  B  are  incorrect.  If  the pain  does  not  subside,  the  client  should  report  to  the  emergency  room.  The  medication should be taken sublingually and should not be crushed, as stated in answer D. 

 



30.  Answer  C  is  correct.  Turkey  contains  the  least  amount  of  fats  and  cholesterol. Liver,  eggs,  beef,  cream sauces,  shrimp,  cheese,  and  chocolate  should  be avoided  by  the  client;  thus,  answers  A,  B,  and  D  are  incorrect.  The  client  should bake meat rather than frying to avoid adding fat to the meat during cooking.  




31.  Answer  B  is  correct.  

The  jugular  veins  in  the  neck  should  be  assessed  for distension.  The  other  parts  of  the  body  will  be  edematous  in  right-sided congestive heart failure, not left-sided; thus, answers A, C, and D are incorrect. 







 32.  Answer  A is  correct.  

The  phlebostatic  axis  is  located  at  the  fifth  intercostals  space midax-illary  line  and  is  the  correct  placement  of  the  manometer.  The  PMI  or  point  of maximal  impulse  is  located  at  the  fifth  intercostals  space  midclavicular  line,  so  answer B  is  incor-rect.  Erb’s  point  is  the  point  at  which  you  can  hear  the  valves  close simultaneously,  mak-ing  answer  C  incorrect.  The  Tail  of  Spence  (the  upper  outer quadrant  of  the  breast)  is  the  area  where  most  breast  cancers  are  located  and  has nothing to do with placement of a manometer; thus, answer D is incorrect.  






33.  Answer B is  correct.  

Zestril  is  an  ACE  inhibitor and  is  frequently  given  with a  diuretic  such  as  Lasix  for hypertension.  Answers  A,  C,  and  D are  incorrect because  the  order  is  accurate.  There  is  no  need  to  question  the  order, administer the medication sepa-rately, or contact the pharmacy.  




34.  Answer  B  is  correct.  

The  best  indicator  of  peripheral  edema  is  measuring  the  extremi-ty.  A paper  tape  measure  should  be  used  rather  than  one  made  of  plastic  or  cloth,  and  the  area should be marked with a pen, providing the most objective assessment.  Answer A  is  incorrect  because  weighing  the  client  will  not  indicate  peripheral edema.  Answer C is  incorrect  because  checking  the  intake  and  output  will not  indicate  periph-eral  edema.  Answer D is  incorrect  because  checking  for pitting edema is less reliable than measuring with a paper tape measure.  




35.  Answer D is  correct.  Clients  with  radium  implants  should  have  close  contact limited  to  30  minutes  per visit.  The  general  rule  is  limiting  time  spent  exposed to  radium,  put-ting  distance  between  people  and  the  radium  source,  and using  lead  to  shield  against  the  radium.  Teaching  the  family  member these principles  is  extremely  important.  Answers  A,  B,  and  C are  not  empathetic and do not address the question; therefore, they are incorrect. 




 36.  Answer  B  is  correct. 

 The  client  with  a  facial  stroke  will  have  difficulty  swallowing  and chewing,  and  the  foods  in  answer  B  provide  the  least  amount  of  chewing.  The  foods  in answers  A,  C,  and  D  would  require  more  chewing  and,  thus,  are  incorrect.   






37.Answer  A is correct.  Novalog  insulin  onsets  very  quickly,  so  food  should  be  available within  10–15  minutes  of  taking  the  insulin.  Answer  B  does  not  address  a  particular  type  of insulin,  so  it  is  incorrect.  NPH  insulin  peaks  in  8–12  hours,  so  a  snack  should  be  eaten  at the  expected  peak  time.  It  may  not  be  3  p.m.  as  stated  in  answer  C.  Answer  D  is  incorrect because there is no need to save the dessert until bedtime.  




38.  Answer  B  is  correct. 

 The  umbilical  cord  needs  time  to  dry  and  fall  off before  putting  the  infant  in  the  tub.  Although  answers  A,  C,  and  D  might  be important, they are not the primary answer to the question.  





39.  Answer D is  correct.  Leucovorin  is  the  antidote  for Methotrexate  and Trimetrexate  which  are  folic  acid  antagonists.  Leucovorin  is  a  folic  acid derivative.  Answers  A,  B,  and  C are  incorrect  because  Leucovorin  does  not treat iron deficiency, increase neu-trophils, or have a synergistic effect.  




40.  Answer A  is  correct.  

The  Hemophilus  influenza  vaccine  is  given  at  4 months  with  the  polio  vaccine.  Answers  B,  C,  and  D are  incorrect  because these vaccines are given later in life.  






41.  Answer  A is  correct.  Proton  pump  inhibitors  should  be  taken  prior  to  the  meal. Answers B, C, and D are incorrect times for giving proton pump inhibitors like Nexium. 

 



42.  Answer  A is  correct.  

If  the  client  is  a  threat  to  the  staff  and  to  other  clients  the nurse  should  call  for  help  and  prepare  to  administer  a  medication  such  as  Haldol to  sedate  him.  Answer  B  is  incorrect  because  simply  telling  the  client  to  calm down  will  not  work.  Answer  C  is  incorrect  because  telling  the  client  that  if  he continues  he  will  be  punished  is  a  threat  and  may  further  anger  him.  Answer  D  is incorrect because if the client is left alone he might harm himself.  





43.  Answer A  is  correct. 

 If  the  fundus  of  the  client  is  displaced  to  the  side,  this might  indicate  a  full  bladder.  The  next  action  by  the  nurse  should  be  to  check for bladder  dis-tention  and  catheterize,  if  necessary.  The  answers  in  B,  C, and D are actions that relate to postpartal hemorrhage. 

 




44.  Answer  C  is  correct. 

 A  low-grade  temperature,  blood-tinged  sputum,  fatigue,  and  night sweats  are  symptoms  consistent  with  tuberculosis.  If  the  answer  in  A  had  said  pneumo-cystis pneumonia,  answer  A  would  have  been  consistent  with  the  symptoms  given  in  the  stem,  but just saying pneumonia isn’t specific enough to diagnose the problem.  Answers B and D are not directly related to the stem. 


 

45.  Answer  B  is  correct.  

If  the  client  has  a  history  of  Prinzmetal’s  angina,  he  should  not be  prescribed  triptan  preparations  because  they  cause  vasoconstriction  and  coronary spasms.  There  is  no  contraindication  for  taking  triptan  drugs  in  clients  with  diabetes, cancer,  or  cluster  headaches  making  answers  A,  C,  and  D  incorrect.   




46.Answer A  is  correct.  Kernig’s  sign  is  positive  if  pain  occurs  on  flexion  of the  hip  and  knee.  The  Brudzinski  reflex  is  positive  if  pain  occurs  on  flexion of  the  head  and  neck  onto  the  chest  so  answer B  is  incorrect.  Answers  C and D might be present but are not related to Kernig’s sign.  





47.  Answer  B  is  correct.  Apraxia  is  the  inability  to  use  objects  appropriately.  Agnosia  is loss  of  sensory  comprehension,  anomia  is  the  inability  to  find  words,  and  aphasia  is the inability to speak or understand so answers A, C, and D are incorrect.  




48.  Answer  C  is  correct.  Increased  confusion  at  night  is  known  as  ―sundowning‖  syndrome.  This  increased  confusion  occurs  when  the  sun  begins  to  set  and  continues during  the  night.  Answer  A  is  incorrect  because  fatigue  is  not  necessarily  present.   Increased  confusion  at  night  is  not  part  of  normal  aging;  therefore,  answer  B  is incor-rect. A delusion is a firm, fixed belief; therefore, answer D is incorrect.  





49.  Answer  C  is  correct.  

The  client  who  is  confused  might  forget  that  he  ate earlier.  Don’t  argue  with  the  client.  Simply  get  him  something  to  eat  that  will satisfy  him  until  lunch.  Answers  A  and  D  are  incorrect  because  the  nurse  is dismissing the client. Answer B is validating the delusion.  



50.  Answer D is  correct.  Nausea  and  gastrointestinal  upset  are  very  common in  clients  taking  acetylcholinesterase  inhibitors  such  as  Exelon.  Other  side effects  include  liver toxicity,  dizziness,  unsteadiness,  and  clumsiness.  The client  might  already  be  experi-encing  urinary  incontinence  or  headaches, but  they  are  not  necessarily  associated;  and  the  client  with  Alzheimer’s disease is already confused. Therefore, answers A, B, and C are incorrect.  




51.  Answer B is  correct.  



Any  lesion  should  be  reported  to  the  doctor.  This  can indicate  a  herpes  lesion.  Clients  with  open  lesions  related  to  herpes  are delivered  by  Cesarean  section  because  there  is  a  possibility  of  transmission of  the  infection  to  the  fetus  with  direct  contact  to  lesions.  It  is  not  enough  to document  the  finding,  so  answer A  is  incorrect.  The  physician  must  make the  decision  to  perform  a  C-section,  making  answer C incorrect.  It  is  not enough to continue primary care, so answer D is incor-rect.  




52.  Answer B is  correct.  

The  client  with  HPV is  at  higher  risk  for cervical  and vaginal  can-cer  related  to  this  STI.  She  is  not  at  higher  risk  for the  other cancers mentioned in answers A, C, and D, so those are incorrect.  






53.  Answer  B  is  correct.  

A  lesion  that  is  painful  is  most  likely  a  herpetic  lesion.  A chancre  lesion  associated  with  syphilis  is  not  painful,  so  answer  A  is  incorrect. Condylomata  lesions  are  painless  warts,  so  answer  D  is  incorrect.  In  answer  C, gonorrhea  does  not  present  as  a  lesion,  but  is  exhibited  by  a  yellow  discharge.   




54.Answer C is  correct.  Florescent  treponemal  antibody  (FTA) is  the  test  for treponema  pallidum.  VDRL  and  RPR are  screening  tests  done  for  syphilis, so  answers  A  and  B  are  incorrect.  The  Thayer-Martin  culture  is  done  for gonorrhea, so answer D is incor-rect.  221

 



55.  Answer  D  is  correct.  

The  criteria  for  HELLP  is  hemolysis,  elevated  liver enzymes,  and  low  platelet  count.  In  answer  A,  an  elevated  blood  glucose  level  is not  associated  with  HELLP.  Platelets  are  decreased,  not  elevated,  in  HELLP syndrome  as  stated  in  answer  B.  The  creatinine  levels  are  elevated  in  renal disease and are not associated with HELLP syndrome so answer C is incorrect. 







 56.  Answer A  is  correct.  Answer B  elicits  the  triceps  reflex,  so  it  is  incorrect. Answer C  elicits  the  patella  reflex,  making  it  incorrect.  Answer D elicits  the radial nerve, so it is incorrect.  




57.  Answer B is  correct.  Brethine  is  used  cautiously  because  it  raises  the  blood glucose  levels.  Answers  A,  C,  and  D are  all  medications  that  are  commonly used in the diabetic client, so they are incorrect.  




58.  Answer  C  is  correct.  When  the  L/S  ratio  reaches  2:1,  the  lungs  are  considered to  be  mature.  The  infant  will  most  likely  be  small  for  gestational  age  and  will  not be  at  risk  for  birth  trauma,  so  answer  D  is  incorrect.  The  L/S  ratio  does  not indicate  congenital  anomalies,  as  stated  in  answer  A,  and  the  infant  is  not  at risk for intrauterine growth retardation, making answer B incorrect.  




59.  Answer  C  is  correct.  Jitteriness  is  a  sign  of  seizure  in  the  neonate.  Crying,  wakefulness, and yawning are expected in the newborn, so answers A, B, and D are incorrect.  





60.  Answer  B  is  correct.  

The  client  is  expected  to  become  sleepy,  have  hot  flashes, and  be  lethargic.  A  decreasing  urinary  output,  absence  of  the  knee-jerk  reflex,  and decreased  respirations  indicate  toxicity,  so  answers  A,  C,  and  D   are incorrect. 

 


61.  Answer  D  is  correct. 

 If  the  client  experiences  hypotension  after  an  injection  of epidur-al  anesthetic,  the  nurse  should  turn  her  to  the  left  side,  apply  oxygen  by mask,  and  speed  the  IV  infusion.  If  the  blood  pressure  does  not  return  to  normal, the  physician  should  be  contacted.  Epinephrine  should  be  kept  for  emergency administration.  Answer  A  is  incorrect  because  placing  the  client  in  Trendelenburg position  (head  down)  will  allow  the  anesthesia  to  move  up  above  the  respiratory center,  thereby  decreasing  the  diaphragm’s  ability  to  move  up  and  down  and ventilate  the  client.  In  answer  B,  the  IV  rate  should  be  increased,  not  decreased. In answer C, the oxygen should be applied by mask, not cannula.  



62.  Answer A  is  correct.  Cancer  of  the  pancreas  frequently  leads  to  severe nausea  and  vomiting  and  altered  glucose  levels.  The  other problems  are  of lesser concern; thus, answers B, C, and D are incorrect.  





63.  Answer C is  correct.  Uremic  frost  is  most  likely  related  to  liver disease.  It  is not  relat-ed  to  anemia,  arteriosclerosis,  or  parathyroid  disorders,  therefore  A, B,  and  D  are  incorrect.   




64.  Answer B is  correct.



The  vital  signs  indicate  hypovolemic  shock.  They  do not  indicate  cerebral  tissue  perfusion,  airway  clearance,  or  sensory perception alterations, so answers A, C, and D are incorrect.  




65.  Answer  A  is  correct.  

The  client  with  osteogenesis  imperfecta  is  at  risk  for pathological  fractures  and  is  likely  to  experience  these  fractures  if  he  participates in contact sports. Answers B, C, and D are not factors for concern. 

 


66.  Answer  D  is  correct. 

 The  client  with  neutropenia  should  not  have  fresh  fruit  because  it should  be  peeled  and/or  cooked  before  eating.  Any  source  of  bacteria  should  be  eliminated, if possible. Answers A, B, and C will not help prevent bacterial invasions.  




67.  Answer  B  is  correct.  

The  client’s  BP  is  low  so  increasing  the  IV  is  priority. Answers A, C, and D are not the first priority therefore they are incorrect.  





68.  Answer  C  is  correct.

  If  the  client  pulls  the  chest  tube  out  of  the  chest,  the  nurse’s  first action  should  be  to  cover  the  insertion  site  with  an  occlusive  dressing.  Afterward,  the nurse  should  call  the  doctor,  who  will  order  a  chest  x-ray  and  possibly  reinsert  the tube. Answers A, B, and D are not the first action to be taken.  




69.  Answer A  is  correct. 

 The  normal  Protime  is  approximately  12–20  seconds. A Protime  of  120  seconds  indicates  an  extremely  prolonged  Protime  and  can result  in  a  sponta-neous  bleeding  episode.  Answers  B,  C,  and  D may  be needed at a later time but are not the most important actions to take first.  



70.  Answer C is  correct.  

The  food  with  the  most  calcium  is  the  yogurt.  Answers A,  B,  and  D are  good  choices,  but  not  as  good  as  the  yogurt,  which  has approximately 400mg of calcium.  




71.  Answer  C  is  correct.  

The  client  receiving  magnesium  sulfate  should  have  a  Foley catheter  in  place,  and  hourly  intake  and  output  should  be  checked.  Answers  A,  B,  and D are incorrect because they do not indicate understanding of MgSO4 toxicity. 

 




72.  Answer D is  correct.  

D is  correct  because  the  best  size  cathlon  to  use  in  a child  receiving  blood  is  a  20  gauge.  A,  B,  and  C are  incorrect  because  the size is either too large or too small.  




73.  Answer B is  correct. 



 The  nurse  should  be  most  concerned  with  laryngeal edema  because  of  the  area  of  burn.  The  next  priority  should  be  answer A, as  well  as  hypona-tremia  and  hypokalemia  in  C and  D,  but  these  answers are not of primary concern so are incorrect. 

 



74.  Answer D is  correct.  

The  client  with  diabetes  indicates  understanding  of  his illness  by  correctly  demonstrating  the  technique  for  administration.  A,  B,  and C are incorrect because they do not indicate understanding.  



75.  Answer  D  is  correct.

  At  this  time,  pain  beneath  the  cast  is  normal.  The client’s  fingers  should  be  warm  to  the  touch,  and  pulses  should  be  present. Paresthesia  is  not  normal  and  might  indicate  compartment  syndrome. Therefore,  Answers  A,  B,  and  C are  incor-rect.   





76.Answer B is  correct. 

 Herbals  can  prolong  bleeding  times  or  interfere  with antiviral  medications,  therefore  the  client  should  avoid  the  use  of  herbals.  A and  D are  not  con-traindicated  for the  client  with  AIDS. C is  incorrect because there is no need to report all changes in skin color.  




77.  Answer  D  is  correct.  

It  is  not  necessary  to  wear  gloves  to  check  the  IV  drip  rate.  The healthcare workers in answers A, B, and C indicate knowledge by their actions.  





78.  Answer  D  is  correct. 

 The  client  that  is  having  ECT  is  given  a  sedative. When  the  blood  pressure  cuff  is  inflated  the  fingers  twitch  when  he  has  a grand  mal  seizure.  A,  B,  and  C  are  incorrect  because  there  is  no  need  for  the nurse to take these interventions prior to ECT.  



79.  Answer  A  is  correct.  Pinworms  cause  rectal  itching.  B,  C,  and  D  are incorrect because they are not signs of pinworms. 





 80.  Answer  B  is  correct.  

Bed  linen  should  be  washed  in  hot  water.  A  is incorrect  because  special  shampoos  can  be  used  by  children  under  age  10. Answers C and D are incor-rect statements therefore they are wrong. 




 81.  Answer  A  is  correct.  

The  pregnant  nurse  can  care  for the  client  with  HIV  if she  uses  standard  precautions.  The  clients  in  answers  B,  C,  and  D  pose  a risk to the pregnant nurse.  






82.  Answer  A  is  correct.  

The  client  with  MRSA  is  placed  on  contact  precautions. The clients in answers B, C, and D pose no risk to themselves or others.  




83.  Answer  D  is  correct.  

The  doctor  could  be  charged  with  malpractice,  which  is failing  to  perform,  or  performing  an  act  that  causes  harm  to  the  client.  Answers  A, B,  and  C  are  incorrect  because  they  apply  to  other  wrongful  acts.  Negligence  is failing  to  perform care  for  the  client;  a  tort  is  a  wrongful  act  committed  on  the client or their belongings; and assault is a violent physical or verbal attack.  






84.  Answer  D  is  correct. 

 The  nursing  assistant  should  not  be  assigned  to  administer  a Fleets  enema.  They  can  administer  a  soap  suds  or  tap  water  enema.  The  other tasks can be performed by the nursing assistant, therefore A, B, and C are incorrect.  




85.  Answer B is  correct.  

The  mother is  most  likely  describing  a  newborn  rash. About  30%  of  all  newborns  have  a  rash  on  the  face  and  forehead  that dissipates in approxi-mately one month. A, C, and D are incorrect actions.  




86.  Answer  B  is  correct.  

The  nurse  who  is  pregnant  should  not  be  assigned  to the  client  with  a  radium  implant.  The  other  nurses  are  not  at  risk  when caring for this client, so A, C, and D are incorrect.  





87.  Answer B is  correct.  

The  Joint  Commission  on  Accreditation  of  Hospitals will  proba-bly  be  interested  in  the  problems  in  answers  A  and  C.  The  failure of  the  nursing  assis-tant  to  care  for the  client  with  hepatitis  might  result  in termination,  but  is  not  of  inter-est  to  the  Joint  Commission.   




88.Answer  B  is  correct. 

 The  next  action  after  discussing  the  problem with  the nurse  is  to  document  the  incident  by  filing  a  formal  reprimand.  If  the  behavior continues  or  if  harm has  resulted  to  the  client,  the  nurse  may  be  terminated  and reported  to  the  Board  of  Nursing,  but  these  are  not  the  first  actions  requested  in the  stem.  A  tort  is  a  wrongful  act  to  the  client  or  his  belongings  and  is  not indicated in this instance. Therefore, Answers A, C, and D are incorrect.  




89.  Answer D is  correct.  

The  client  at  highest  risk  for  complications  is  the  client with  mul-tiple  sclerosis  who  is  being  treated  with  cortisone  via  the  central  line. The clients in answers A, B, and C are more stable and can be seen later. 

 


90.  Answer  B  is  correct.

  The  pregnant  client  and  the  client  with  a  broken  arm are the  best  choices  for  placing  in  the  same  room.  The  clients  in  answers  A,  C,  and  D need to be placed in separate rooms due to the serious natures of their injuries.  




91.  Answer A  is  correct.  Before  instilling  the  eardrops,  the  nurse  should consider  the  age  of  the  child  because  the  ear should  be  pulled  down  and  out to  best  deliver the  drops  in  the  ear canal.  B,  C,  and  D  are  not  considerations when instilling eardrops in a small child.  







92.  Answer C is  correct.  Remember the  ABCs  (airway,  breathing,  circulation) when  answering  this  question.  Answer C is  correct  because  a  hotdog  is  the size  and  shape  of  the  child’s  trachea  and  poses  a  risk  of  aspiration.  Answers A,  B,  and  D are  incorrect  because  white  grape  juice,  a  grilled  cheese sandwich, and ice cream do not pose a risk of aspiration for a child.  





93.  Answer  C  is  correct.  

A  viral  load  of  200  is  extremely  low.  This  indicates  that  the  client has a low risk for opportunistic illnesses. A, B, and D do not indicate understanding.  





94.  Answer B is  correct.  

Lantus  insulin  cannot  be  mixed  with  other insulins, but  can  be  taken  by  the  client  taking  regular  insulin.  A,  C, and  D are  not correct methods of administering Lantus insulin with regular insulin.  




95.  Answer  C  is  correct.  Always  remember  your  ABCs  (airway,  breathing,  circulation) when selecting an answer. A, B, and D are incorrect because they are not the priority.  




96.  Answer A  is  correct.  

The  client  with  glomerulonephritis  will  probably  have hyperten-sion.  B and  C are  vague  answers  and  are  therefore  incorrect.  D does not directly relate to glomerulonephritis.  



97.  Answer  B  is  correct.  

A  child  with  epiglottis  has  the  possibility  of  complete  obstruction of  the  airway.  For  this  reason  the  nurse  should  not  evaluate  the  airway  using  a  tongue blade. A, C, and D are allowed actions and are therefore incorrect. 



 98.  Answer  C  is  correct.  Exophthalmos  (protrusion  of  eyeballs)  often  occurs  with hyperthy-roidism.  The  client  with  hyperthyroidism will  often  exhibit  tachycardia, increased appetite, and weight loss; therefore, answers A, B, and D are incorrect.  



99.  Answer D is  correct.  

The  child  with  celiac  disease  should  be  on  a  glutenfree  diet.  Answers  A,  B,  and  C  all  contain  gluten,  while  answer D gives  the only  choice  of  foods  that  does  not  contain  gluten.   



100.Answer  C  is  correct.  Remember  the  ABCs  (airway,  breathing,  circulation)  when answering  this  question.  Before  notifying  the  physician  or  assessing  the  pulse,  oxygen should  be  applied  to  increase  the  oxygen  saturation,  so  answers  A  and  D  are  incorrect. The normal oxygen saturation is 92%–100%, making answer B incorrect





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