Thursday, 31 December 2015

PRACTICE QUESTIONS PART =08 ANSWERS AND RATIONALE


NCLEX PRACTICE QUESTIONS PART = 08 ANSWERS AND RATIONALE 



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(Q.No.201 to 250) 





201.  Answer D is  correct.  Methotrexate  is  a  folic  acid  antagonist.  Leucovorin is  the  drug  given  for  toxicity  to  this  drug.  It  is  not  used  to  treat  irondeficiency  anemia,  create  a  synergistic  effects,  or increase  the  number  of circulating  neutrophils.  Therefore,  answers  A,  B,  and  C  are  incorrect.   



202.  Answer  B  is  correct.  The  client  who  is  allergic  to  dogs,  eggs,  rabbits,  and  chicken feathers  is  most  likely  allergic  to  the  rubella  vaccine.  The  client  who  is  allergic  to neomycin  is  also  at  risk.  There  is  no  danger  to  the  client  if  he  has  an  order  for  a  TB skin test, ELISA test, or chest x-ray; thus, answers A, C, and D are incorrect.  



203.  Answer  B  is  correct.  Zantac  (rantidine)  is  a  histamine  blocker  that  should  be  given with  meals  for  optimal  effect,  not  before  meals.  However,  Tagamet  (cimetidine)  is  a histamine  blocker  that  can  be  given  in  one  dose  at  bedtime.  Neither  of  these  drugs should be given before or after meals, so answers A and D are incorrect.  




204.  Answer C is  correct.  The  proximal  end  of  the  double-barrel  colostomy  is the  end  toward  the  small  intestines.  This  end  is  on  the  client’s  right  side. The distal end, as in answers A, B, and D, is on the client’s left side.  




205.  Answer  A is  correct.  If  the  nurse  checks  the  fundus  and  finds  it  to  be  displaced to  the  right  or  left,  this  is  an  indication  of  a  full  bladder.  This  finding  is  not associated  with  hypotension  or  clots,  as  stated  in  answer  B.  Oxytoxic  drugs (Pitocin)  are  drugs  used  to  contract  the  uterus,  so  answer  C  is  incorrect.  It  has nothing  to  do  with  displace-ment  of  the  uterus.  Answer  D  is  incorrect  because displacement is associated with a full bladder, not vaginal bleeding.  




206.  Answer C is  correct.  Clients  with  an  internal  defibrillator or  a  pacemaker should  not  have  an  MRI because  it  can  cause  dysrhythmias  in  the  client  with a  pacemaker.  If  the  client  has  a  need  for  oxygen,  is  claustrophobic,  or  is deaf,  he  can  have  an  MRI,  but  provisions  such  as  extension  tubes  for the oxygen,  sedatives,  or  a  signal  system  should  be  made  to  accommodate these problems. Therefore, answers A, B, and D are incorrect.  



207.  Answer  C  is  correct.  A  6-month-old  is  too  old  for  the  colorful  mobile.  He  is  too  young to  play  with  the  electronic  game  or  the  30-piece  jigsaw  puzzle.  The  best  toy  for  this  age is the cars in a plastic container, so answers A, B, and D are incorrect.  




208.  Answer  C  is  correct.  The  client  with  polio  has  muscle  weakness.  Periods  of  rest throughout  the  day  will  conserve  the  client’s  energy.  A  hot  bath  can  cause  burns;  however,  a  warm  bath  would  be  helpful,  so  answer  A  is  incorrect.  Strenuous  exercises  are not  advisable,  making  answer  B  incorrect.  Visual  disturbances  that  are  directly  associated with polio that cannot be corrected with glasses; therefore, answer D is incorrect.  




209.  Answer  B  is  correct.  The  client  with  a  protoepisiotomy  will  need  stool  softeners such  as  docusate  sodium.  Suppositories  are  given  only  with  an  order  from the doctor,  Methergine  is  a  drug  used  to  contract  the  uterus,  and  Parlodel  is  an  antiParkinsonian drug; therefore, answers A, C, and D are incorrect.  




210.  Answer  C  is  correct.  Total  Parenteral  Nutrition  is  a  high-glucose  solution.  This therapy  often  causes  the  glucose  levels  to  be  elevated.  Because  this  is  a  common complica-tion,  insulin  might  be  ordered.  Answers  A,  B,  and  D  are  incorrect.  TPN  is used  to  treat  negative  nitrogen  balance;  it  will  not  lead  to  negative  nitrogen  balance. Total  Parenteral  Nutrition  can  be  managed  with  oral  hypoglycemic  drugs,  but  it  is difficult  to  do  so.  Total  Parenteral  Nutrition  will  not  lead  to  further  pancreatic  disease.




211.  Answer B is  correct.  The  client  who  is  10  weeks  pregnant  should  be assessed  to  determine  how  she  feels  about  the  pregnancy.  It  is  too  early  to discuss  preterm  labor,  too  late  to  discuss  whether  she  was  using  a  method of  birth  control,  and  after the  client  delivers,  a  discussion  of  future  children should be instituted. Thus, answers A, C, and D are incorrect.  




212.  Answer A  is  correct.  The  best  IV  fluid  for correction  of  dehydration  is normal  saline  because  it  is  most  like  normal  serum.  Dextrose  pulls  fluid  from the  cell,  lactated  Ringer’s  contains  more  electrolytes  than  the  client’s  serum, and  dextrose  with  normal  saline  will  also  alter the  intracellular  fluid. Therefore, answers B, C, and D are incor-rect.  




213.  Answer  A  is  correct.  A  thyroid  scan  uses  a  dye,  so  the  client  should  be  assessed  for allergies  to  iodine.  The  client  will  not  have  a  bolus  of  fluid,  will  not  be  asleep,  and  will not have a urinary catheter inserted, so answers B, C, and D are incorrect.  




214.  Answer  B  is  correct.  RhoGam  is  used  to  prevent  formation  of  Rh  antibodies.  It  does  not provide  immunity  to  Rh  isoenzymes,  eliminate  circulating  Rh  antibodies,  or  con-vert  the  Rh factor from negative to positive; thus, answers A, C, and D are incorrect.  




215.  Answer  B  is  correct.  A  client  with  a  fractured  foot  often  has  a  short  leg  cast  applied  to stabilize  the  fracture.  A  spica  cast  is  used  to  stabilize  a  fractured  pelvis  or  vertebral fracture.  Kirschner  wires  are  used  to  stabilize  small  bones  such  as  toes  and  the  client will most likely have a cast or immobilizer, so answers A, C, and D are incorrect.  




216.  Answer  A is  correct.  Iridium  seeds  can  be  expelled  during  urination,  so  the client  should  be  taught  to  strain  his  urine  and  report  to  the  doctor  if  any  of  the seeds  are  expelled.  Increasing  fluids,  reporting  urinary  frequency,  and  avoiding prolonged sitting are not necessary; therefore, answers B, C, and D are incorrect.  




217.  Answer C is  correct.  Immunosuppressants  are  used  to  prevent  antibody formation.  Antivirals,  antibiotics,  and  analgesics  are  not  used  to  prevent antibody production, so answers A, B, and D are incorrect.  




218.  Answer  A is  correct.  Before  cataract  removal,  the  client  will  have  Mydriatic drops  instilled  to  dilate  the  pupil.  This  will  facilitate  removal  of  the  lens.  Miotics constrict  the  pupil  and  are  not  used  in  cataract  clients.  A  laser  is  not  used  to smooth  and  reshape  the  lens;  the  diseased  lens  is  removed.  Silicone  oil  is  not injected in this client; thus, answers B, C, and D are incorrect.  




219.  Answer  C  is  correct.  Placing  simple  signs  that  indicate  the  location  of  rooms  where the  client  sleeps,  eats,  and  bathes  will  help  the  client  be  more  independent.  Providing mirrors  and  pictures  is  not  recommended  with  the  client  who  has  Alzheimer’s  disease because  mirrors  and  pictures  tend  to  cause  agitation,  and  alternating  healthcare  workers confuses the client; therefore, answers A, B, and D are incorrect.  




220.  Answer C is  correct.  
A Jackson-Pratt  drain  is  a  serum-collection  device commonly  used  in  abdominal  surgery.  A  Jackson-Pratt  drain  will  not  prevent the  need  for dress-ing  changes,  reduce  edema  of  the  incision,  or  keep  the common  bile  duct  open,  so  answers  A,  B,  and  D are  incorrect.  A  t-tube  is used  to  keep  the  common  bile  duct  open.






221.  Answer C is  correct.  The  infant  who  is  32  weeks  gestation  will  not  be  able to  control  his  head,  so  head  lag  will  be  present.  Mongolian  spots  are common  in  African  American  infants,  not  Caucasian  infants;  the  client  at  32 weeks  will  have  scrotal  rugae  or redness.  There  is  no  alteration  in  the amount of amniotic fluid; therefore, answers A, B, and D are incorrect.  




222.  Answer  A is  correct.  Hematuria  in  a  client  with  a  pelvic  fracture  can  indicate  trauma  to the  bladder  or  impending  bleeding  disorders.  It  is  not  unusual  for  the  client  to  com-plain of  muscles  spasms  with  multiple  fractures,  so  answer  B  is  incorrect.  Dizziness  can  be associated  with  blood  loss  and  is  nonspecific,  making  answer  C  incorrect.  Nausea,  as stated in answer D, is also common in the client with multiple traumas.  




223.  Answer  C  is  correct.  The  client’s  statement  ―They  are  trying  to  kill  me‖  indicates  paranoid  delusions.  There  is  no  data  to  indicate  that  the  client  is  hearing  voices  or  is  intoxicated,  so  answers  A  and  D  are  incorrect.  Delusions  of  grandeur  are  fixed  beliefs  that the client is superior or perhaps a famous person, making answer B incorrect.  




224.  Answer B is  correct.  Because  the  nurse  is  unaware  of  when  the  bottle  was opened  or  whether  the  saline  is  sterile,  it  is  safest  to  obtain  a  new  bottle. Answers A, C, and D are not safe practices.  




225.  Answer C is  correct.  Infants  with  an  Apgar  of  9  at  5  minutes  most  likely have  acry-ocyanosis,  a  normal  physiologic  adaptation  to  birth.  It  is  not  related to  the  infant  being  hypothermic,  experiencing  bradycardia,  or being  lethargic; thus, answers A, B, and D are incorrect.  




226.  Answer A  is  correct.  Rapid  continuous  rewarming  of  a  frostbite  primarily lessens  cel-lular  damage.  It  does  not  prevent  formation  of  blisters.  It  does promote  movement,  but  this  is  not  the  primary  reason  for  rapid  rewarming.  It might  increase  pain  for  a  short  period  of  time  as  the  feeling  comes  back  into the extremity; therefore, answers B, C, and D are incorrect.  




227.  Answer D is  correct.  Hemodialysis  works  by  using  a  dialyzing  membrane to  filter  waste  that  has  accumulated  in  the  blood.  It  does  not  pass  water through  a  dialyzing  membrane  nor does  it  eliminate  plasma  proteins  or lower the pH, so answers A, B, and C are incorrect.  




228.  Answer  B  is  correct.  The  client  who  is  immune-suppressed  and  is  exposed  to measles  should  be  treated  with  medications  to  boost  his  immunity  to  the  virus. An  antibiotic  or  antiviral  will  not  protect  the  client  and  it  is  too  late  to  place  the client in isolation, so answers A, C, and D are incorrect.  




229.  Answer  D  is  correct.  The  client  with  MRSA  should  be  placed  in  isolation.  Gloves, a  gown,  and  a  mask  should  be  used  when  caring  for  the  client  and  hand  washing is  very  important.  The  door  should  remain  closed,  but  a  negative-pressure  room is not  neces-sary,  so  answers  A  and  B  are  incorrect.  MRSA  is  spread  by  contact with  blood  or  body  fluid  or  by  touching  the  skin  of  the  client.  It  is  cultured  from the nasal  passages  of  the  client,  so  the  client  should  be  instructed  to  cover  his  nose and  mouth  when  he  sneezes  or  coughs.  It  is  not  necessary  for  the  client  to  wear the  mask  at  all  times;  the  nurse  should  wear  the  mask,  so  answer  C  is  incorrect. 




230.  Answer  B  is  correct.  Pain  related  to  phantom limb  syndrome  is  due  to peripheral  nerv-ous  system interruption.  Answer  A  is  incorrect  because  phantom limb  pain  can  last  sev-eral  months  or  indefinitely.  Answer  C  is  incorrect  because it is not psychological. It is also not due to infections, as stated in answer D.  




231.  Answer A  is  correct.  During  a  Whipple  procedure  the  head  of  the  pancreas, which  is  a  part  of  the  stomach,  the  jejunum,  and  a  portion  of  the  stomach  are removed  and  reanastomosed.  Answer B  is  incorrect  because  the  proximal third  of  the  small  intes-tine  is  not  removed.  The  entire  stomach  is  not removed, as in answer C, and in answer D, the esophagus is not removed.  




232.  Answer  C  is  correct.  Pepper  is  not  processed  and  contains  bacteria. Answers  A,  B,  and  D  are  incorrect  because  fruits  should  be  cooked  or washed and peeled, and salt and ketchup are allowed.  



233.  Answer  A is  correct.  Coumadin  is  an  anticoagulant.  One  of  the  tests  for bleeding  time  is  a  Protime.  This  test  should  be  done  monthly.  Eating  more  fruits and  vegetables  is  not  necessary,  and  dark-green  vegetables  contain  vitamin  K, which  increases  clotting,  so  answer  B  is  incorrect.  Drinking  more  liquids  and avoiding crowds is not necessary, so answers C and D are incorrect.  




234.  Answer A  is  correct.  The  client  who  is  having  a  central  venous  catheter removed  should  be  told  to  hold  his  breath  and  bear  down.  This  prevents  air from entering the line. Answers B, C, and D will not facilitate removal.  




235.  Answer  B  is  correct.  Clients  with  a  history  of  streptococcal  infections  could  have anti-bodies  that  render  the  streptokinase  ineffective.  There  is  no  reason  to  assess the  client  for  allergies  to  pineapples  or  bananas,  there  is  no  correlation  to  the  use of  phenytoin  and  streptokinase,  and  a  history  of  alcohol  abuse  is  also  not  a  factor in the order for streptokinase; therefore, answers A, C, and D are incorrect.  




236.  Answer  B  is  correct.  The  client  who  is  immune-suppressed  and  has  bone marrow  suppression  should  be  taught  not  to  floss  his  teeth  because  platelets are  decreased.  Using  oils  and  cream-based  soaps  is  allowed,  as  is  eating  salt and using an electric razor; therefore, answers A, C, and D are incorrect.  




237.  Answer  A is  correct.  The  best  method  and  safest  way  to  change  the  ties  of  a tra-cheotomy  is  to  apply  the  new  ones  before  removing  the  old  ones.  B  is incorrect  because  having  a  helper  is  good,  but  the  helper  might  not  prevent  the client  from coughing  out  the  tracheotomy.  Answer  C  is  not  the  best  way  to prevent  the  client  from coughing  out  the  tracheotomy.  D  is  incorrect  because asking the doctor to suture the tracheotomy in place is not appropriate.  




238.  Answer  D  is  correct.  The  output  of  300mL  is  indicative  of  hemorrhage  and should  be  reported  immediately.  Answer  A  does  nothing  to  help  the  client.  Milking the  tube  is  done  only  with  an  order  and  will  not  help  in  this  situation,  and  slowing the intravenous infusion is not correct; thus, answers B and C are incorrect.  




239.  Answer A  is  correct.  The  infant  with  tetralogy  of  Fallot  has  four heart defects.  He  will  be  treated  with  digoxin  to  slow  and  strengthen  the  heart. Epinephrine,  aminophyline,  and  atropine  will  speed  the  heart  rate  and  are not  used  in  this  client;  therefore,  answers  B,  C,  and  D are  incorrect. 




241.  Answer A  is  correct.  The  toddler with  a  ventricular  septal  defect  will  tire easily.  He  will  not  grow  normally  but  will  not  need  more  calories.  He  will  be susceptible  to  bacterial  infection,  but  he  will  be  no  more  susceptible  to  viral infections than other children. Therefore, answers B, C, and D are incorrect.  




242.  Answer  B  is  correct.  A  nonstress  test  determines  periodic  movement  of the  fetus.  It  does  not  determine  lung  maturity,  show  contractions,  or measure neurological well-being, making answers A, C, and D incorrect.  




245.  Answer  B  is  correct.  Lovenox  injections  should  be  given  in  the  abdomen,  not  in  the deltoid  muscle.  The  client  should  not  aspirate  after  the  injection  or  clear  the  air  from the syringe before injection. Therefore, answers A, C, and D are incorrect.  




246.  Answer B is  correct.  Valium  is  not  given  in  the  same  syringe  with  other medications,  so  answer A  is  incorrect.  These  medications  can  be  given  to the  same  client,  so  answer D is  incorrect.  In  answer C,  it  is  not  necessary  to wait  to  inject  the  second  medication.  Valium  is  an  antianxiety  medication, and Phenergan is used as an antiemetic.  




247.  Answer B is  correct.  Voiding  every  3  hours  prevents  stagnant  urine  from collecting  in  the  bladder,  where  bacteria  can  grow.  Douching  is  not recommended  and  obtaining  a  urinalysis  monthly  is  not  necessary,  making answers  A  and  C incorrect.  The  client  should  practice  wiping  from  front  to back after voiding and bowel movements, so answer D is incorrect.  



248.  Answer C is  correct.  Of  these  clients,  the  one  who  should  be  assigned  to the  care  of  the  nursing  assistant  is  the  client  with  dementia.  Only  an  RN or the  physician  can  place  the  client  in  seclusion,  so  answer A  is  incorrect.  The nurse  should  empty  the  Foley  catheter of  the  preeclamptic  client  because  the client  is  unstable,  making  answer B  incorrect.  A  nurse  or  physical  therapist should ambulate the client with a fractured hip, so answer D is incorrect.  



249.  Answer A  is  correct.  The  client  who  has  recently  had  a  thyroidectomy  is  at risk  for  tracheal  edema.  A  padded  tongue  blade  is  used  for  seizures  and  not for the  client  with  tracheal  edema,  so  answer B  is  incorrect.  If  the  client experiences  tracheal  edema,  the  endotracheal  tube  or airway  will  not  correct the problem, so answers C and D are incorrect.  





250.  Answer  D  is  correct.  Histoplasmosis  is  a  fungus  carried  by  birds.  It  is  not  transmitted to  humans  by  cats,  dogs,  or  turtles.  Therefore,  answers  A,  B,  and  C  are  incorrect.             


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