Sample NCLEX Questions
1. A 14-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive?
a. Hepatitis B
b. Inactivated polio
c. Diphtheria, acellular pertussis, tetanus (DTaP)
d. Mumps, measles, rubella (MMR)
Answer B
Rationale: The measles portion of the MMR vaccine is grown in chick embryo cells. The current MMR vaccine does not contain a significant amount of egg proteins, and even children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction. However, patients that do respond to egg contact with anaphylaxis should be in a medically controlled setting where full resuscitation efforts can be administered if anaphylaxis results. The vaccines in options 1-3 do not contain egg protein.
2. The Gell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by:
a. Immunoglobulin E (IgE)
b. Immunoglobulin G (IgG)
c. Immunoglobulin A (IgA)
d. Immunoglobulin M (IgM).
Answer A
Rationale: IgE, the least common serum immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological mediators that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class of Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the second most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is important in local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to be made by the fetus and the first Ig to be made by a virgin B cell when it is stimulated by antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms.
3. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:
a. Aplastic anemia
b. Thrombocytosis
c. Leukocytosis
d. Granulocytosis
Answer A
Rationale: Aplastic anemia is the result of a hypersensitivity reaction and is often irreversible. It leads to pancytopenia, a severe decrease in all cell types: red blood cells, white blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to drop. A reduced number of white blood cells makes the patient susceptible to infection. And, a reduced number of platelets causes the blood not to clot as easily. Treatment for mild cases is supportive. Transfusions may be necessary. Severe cases require a bone marrow transplant. Option 2 is an elevated platelet count. Option 3 is an elevated white count. Option 4 is an elevated granulocyte count. A granulocyte is a type of white blood cell.
4. Serious adverse effects of oral contraceptives include:
a. Increase in skin oil followed by acne.
b. Headache and dizziness.
c. Early or mid-cycle bleeding.
d. Thromboembolic complications.
Answer B
Rationale: Oral contraceptives have been associated with an increased risk of stroke, myocardial infarction, and deep vein thrombosis. These risks are increased in women who smoke. Increased skin oil and acne are effects of progestin excess. Headache and dizziness are effects of estrogen excess. Early or mid-cycle bleeding are effects of estrogen deficiency.
5. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is:
a. Apnea
b. Bleeding tendencies
c. Hypotension
d. Pyrexia
Answer: A
Rationale: All items are adverse reactions of the drug. However, apnea appearing during the first hour of drug infusion occurs in 10-12 percent of neonates with congenital heart defects. Clinicians deciding to utilize alprostadil must be prepared to intubate and mechanically ventilate the infant. Careful monitoring for apnea or respiratory depression is mandatory. In some institutions, elective intubation occurs prior to initiation of the medication.
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