Published - Thu, 23 Feb 2023

NCLEX-RN Exam Questions - Part 160

1. When assessing a client, the nurse notes the typical skin rash seen with systemic lupus erythematosus. Which of the following descriptions correctly describes this rash?

A) Small round or oval reddish brown macules scattered over the entire body
B) Scattered clusters of macules, papules, and vesicles over the body
C) Bright red appearance of the palmar surface of the hands
D) Reddened butterfly shaped rash over the cheeks and nose

2. The nurse notes multiple bruises on the arms and legs of a newly admitted client with lupus. The client states, 'I get them whenever I bump into anything.' The nurse would expect to note a decrease in which of the following laboratory tests?

A) Number of platelets
B) WBC count
C) Hemoglobin level
D) Number of lymphocytes

3. A client is started on prednisone 2.5 mg po bid. Which of the following instructions should be included in her discharge teaching specific to this medication?

A) Increase your oral intake of fluids to at least 4000 mL every day.
B) Avoid contact with people who have contagious illnesses.
C) Brush your teeth at least 4 times a day with a firm toothbrush.
D) Immediately stop taking the prednisone if you feel depressed.

4. During the assessment, the nurse observes a client scratching his skin. He has been admitted to rule out Laennecs cirrhosis of the liver. The nurse knows the pruritus is directly related to:

A) A loss of phagocytic activity
B) Faulty processing of bilirubin
C) Enhanced detoxification of drugs
D) The formation of collateral circulation

5. Four days after admission for cirrhosis of the liver, the nurse observes the following when assessing a male client: increased irritability, asterixis, and changes in his speech pattern. Which of the following foods would be appropriate for his bedtime snack?

A) Fresh fruit
B) A milkshake
C) Saltine crackers and peanut butter
D) A ham and cheese sandwich

1. Right Answer: D
Explanation: (A) The appearance of small, round or oval reddish brown macules scattered over the entire body is characteristic of rubeola. (B) The appearance of scattered clusters of macules, papules, and vesicles throughout the body is characteristic of chickenpox. (C) Palmar redness is seen in clients with cirrhosis of the liver. (D)The characteristic butterfly rash over the cheek and nose and into the scalp is seen with systemic lupus erythematosus.

2. Right Answer: A
Explanation: (A) Thrombocytopenia, a decrease in platelets, occurs in lupus and causes a decrease in blood coagulation and thrombus formation. (B) Clients with lupus will have a decrease in the WBC count decreasing their resistance to infection. (C) Clients with lupus may have a decrease in the hemoglobin level causing anemia.(D) Leukopenia, a decrease in white blood cells, is seen in lupus and decreases resistance to infection.

3. Right Answer: B
Explanation: (A) Fluid retention is a side effect of prednisone. The nurse should teach clients to weigh themselves daily and to observe for signs of edema. If these signs of fluid retention occur, they should notify the physician. (B) Prednisone, a glucocorticoid, suppresses the normal immune response making the client more susceptible to infections. (C) An increase in bleeding tendencies is a side effect of prednisone therapy. The nurse should teach clients to use preventive measures (i.e., electric razors and soft toothbrushes). (D) Depression and personality changes are side effects of prednisone therapy. Prednisone should never be discontinued abruptly.

4. Right Answer: B
Explanation: (A) A loss in the phagocytic activity of the Kupffer cells occurs with cirrhosis of the liver, which increases the susceptibility to infections. (B) The faulty processing of bilirubin produces bilesalts, which are irritating to the skin. (C) The detoxification of drugs is impaired with cirrhosis of the liver. (D) Collateral circulation develops due to portal hypertension. This is manifest through the development of esophageal varices, hemorrhoids, and caput medusae.

5. Right Answer: A
Explanation: (A) High levels of ammonia, a by-product of protein metabolism, can precipitate metabolic encephalopathy. These clients need a diet high in carbohydrates and bulk. (B) Metabolic encephalopathy of the brain associated with liver failure is precipitated by elevated ammonia levels. Ammonia is a by-product of protein metabolism. (C, D) Metabolic encephalopathy in liver failure is precipitated by elevated ammonia levels. Ammonia is a by-product of protein metabolism.

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