NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 281:

  Which of the following signs and symptoms indicates a tension pneumothorax as compared to an open pneumothorax?

  A. Ventilation-perfusion (V./Q.) mismatch
  B. Hypoxemia and respiratory acidosis
  C. Mediastinal tissue and organ shifting
  D. Decreased tidal volume and tachypnea
  C. Mediastinal tissue and organ shifting

  ---

  (A, B, D) These occur in both tension pneumothorax and open pneumothorax. (C) The tension pneumothorax acts like a one- way valve so that the pneumothorax increases with each breath. Eventually, it occupies enough space to shift mediastinal tissue toward the unaffected side away from the midline. Tracheal deviation, movement of point of maximum impulse, and decreased cardiac output will occur. The other three options will occur in both types of pneumothorax.

• Question 282:

  A client is now pregnant for the second time. Her first child weighed 4536 g at delivery. The client's glucose tolerance test shows elevated blood sugar levels. Because she only shows signs of diabetes when she is pregnant, she is classified as having:

  A. Insulin-dependent diabetes
  B. Type II diabetes mellitus
  C. Type I diabetes mellitus
  D. Gestational diabetes mellitus
  D. Gestational diabetes mellitus

  ---

  (A) Insulin-dependent diabetes mellitus, also known as type I diabetes, usually appears before the age of 30 years with an abrupt onset of symptoms requiring insulin for management. It is not related to onset during pregnancy. (B) Non-insulin璬ependent diabetes (type II diabetes) usually appears in older adults. It has a slow onset and progression of symptoms. (C) This type of diabetes is the same as insulin-dependent diabetes. (D) Gestational diabetes mellitus has its onset of symptoms during pregnancy and usually disappears after delivery. These symptoms are usually mild and not life threatening, although they are associated with increased fetal morbidity and other fetal complications.

• Question 283:

  A client's behavior is annoying other clients on the unit. He is meddling with their belongings and dominating the group. The best approach by the nurse is to:

  A. Seclude him in his room.
  B. Set limits on his behavior.
  C. Have his medication increased.
  D. Ignore him and tell the other clients that these behaviors are due to his illness and that they should understand.
  B. Set limits on his behavior.

  ---

  (A) This action by the nurse would be punitive. (B) Consistent limit setting will help the client to know what is acceptable behavior. (C) This action is not within the nurse's scope of practice. (D) This could be dangerous to the client and to others and violates other clients' rights.

• Question 284:

  At 38 weeks' gestation, a client is in active labor. She is using her Lamaze breathing techniques. The RN is coaching her breathing and encouraging her to relax and work with her contractions. Which one of the following complaints by the client will alert the RN that she is beginning to hyperventilate with her breathing?

  A. "I am cold."
  B. "I have a backache."
  C. "I feel dizzy."
  D. "I am nauseous."
  C. "I feel dizzy."

  ---

  (A) Cold is not a symptom of hyperventilation. This could be due to the temperature of the room. (B) Backache is not a symptom of hyperventilation. This is probably due to the gravid uterus and its effect on the back muscles, or it may be due to the client's position in bed. (C) Dizziness is the first symptom of hyperventilation. It occurs because the body is eliminating too much CO2. (D) Nausea is not a symptom of hyperventilation. It could be a symptom of pain.

• Question 285:

  When interviewing parents who are suspected of child abuse, the nurse would use which of the following interview techniques?

  A. Be direct, honest, and attentive.
  B. Approach them in the emergency room as soon as you suspect abuse to "clear the air" right away.
  C. Ask the parents what they could have done differently to prevent this from happening to the child.
  D. After the interview, call child protective services.
  A. Be direct, honest, and attentive.

  ---

  (A) The nurse must be honest, direct, professional, and attentive in her interview to gain the parent's trust. (B) The nurse should approach the parents in private, away from the child. (C) Asking them to relive and evaluate the situation may be looked at as placing blame on the parents for the child's "accident." At this point, the parents may get defensive and stop communicating. (D) Although you may call child protective services, the nurse should inform the parents of their responsibility to do this and explain the process to them.

• Question 286:

  A client is admitted to the hospital with a diagnosis of aplastic anemia and placed on isolation. The nurse notices a family member entering the room without applying the appropriate apparel. The nurse will approach the family member using the following information as a basis for discussion:

  A. The risks of exposure of the visitor to infectious organisms is great.
  B. Hospital regulations mandate that everyone in the facility adhere to appropriate codes.
  C. The client is at extreme risk of acquiring infections.
  D. Adherence to the guidelines are the latest Centers for Disease Control and Prevention recommendations on use of protective apparel.
  C. The client is at extreme risk of acquiring infections.

  ---

  (A) Although clients with a compromised immune system may acquire infections, the primary emphasis is on protecting the client. (B, D) Most people are aware of the guidelines once they see posted signs, so quoting regulations is not likely to result in consistent adherence to regulations. (C) Clients with aplastic anemia have white cell counts of 2000 or lower, making them more vulnerable to infections from others.

• Question 287:

  As a nurse in the emergency room, you receive an outside call from an elderly woman who states she has just been raped. She states, "I know I must come to the hospital, but what do I do next?" You advise her to call the police, then come to the hospital emergency room. What action by the nurse would indicate an understanding of the examination process once the victim enters the emergency room?

  A. Inform the victim not to wash, change clothes, douche, brush teeth, or eat or drink anything.
  B. Inform the victim to bring insurance information with her to the hospital so she can be properly cared for.
  C. Phone a rape counselor to begin working with the victim as soon as she enters the hospital.
  D. Do not leave the victim alone to collect her thoughts.
  A. Inform the victim not to wash, change clothes, douche, brush teeth, or eat or drink anything.

  ---

  (A) Providing the victim with these instructions will aid in the determination of physical evidence of rape. Victims frequently feel "dirty" after rape, and their first instinct is to take care of personal hygiene before facing anyone. (B) This action is of lesser importance at this time. (C) Although this is a nursing measure appropriate in this situation, contacting a counselor can be done once the victim enters the hospital. Frequently victims call but do not follow up with the visit. (D) Once the victim enters the emergency room, it is important not to leave her alone.

• Question 288:

  A client had a cardiac catheterization with angiography and thrombolytic therapy with streptokinase. The nurse should initiate which of the following interventions immediately after he returns to his room?

  A. Place him on NPO restriction for 4 hours.
  B. Monitor the catheterization site every 15 minutes.
  C. Place him in a high Fowler position.
  D. Ambulate him to the bathroom to void.
  B. Monitor the catheterization site every 15 minutes.

  ---

  (A) A contrast dye, iodine, is used in this procedure. This dye is nephrotoxic. The client must be encouraged to drink plenty of liquids to assist the kidneys in eliminating the dye. (B) Streptokinase activates plasminogen, dissolving fibrin deposits. To prevent bleeding, pressure is applied at the insertion site. The client is assessed for both internal and external bleeding. (C) The extremity used for the insertion site must be kept straight and be immobilized because of the potential for bleeding. (D) The client is kept on bed rest for 8?2 hours following the procedure because of the potential for bleeding.

• Question 289:

  A long-term goal for the nurse in planning care for a depressed, suicidal client would be to:

  A. Provide him with a safe and structured environment.
  B. Assist him to develop more effective coping mechanisms.
  C. Have him sign a "no-suicide" contract.
  D. Isolate him from stressful situations that may precipitate a depressive episode.
  B. Assist him to develop more effective coping mechanisms.

  ---

  (A) This statement represents a short-term goal. (B) Long-term therapy should be directed toward assisting the client to cope effectively with stress. (C) Suicide contracts represent short-term interventions. (D) This statement represents an unrealistic goal. Stressful situations cannot be avoided in reality.

• Question 290:

  A 44-year-old female client is receiving external radiation to her scapula for metastasis of breast cancer.

  Teaching related to skin care for the client would include which of the following?

  A. Teach her to completely clean the skin to remove all ointments and markings after each treatment.
  B. Teach her to cover broken skin in the treated area with a medicated ointment.
  C. Encourage her to wear a tight-fitting vest to support her scapula.
  D. Encourage her to avoid direct sunlight on the area being treated.
  D. Encourage her to avoid direct sunlight on the area being treated.

  ---

  (A) The skin in a treatment area should be rinsed with water and patted dry. Markings should be left intact, and the skin should not be scrubbed. (B) Clients should avoid putting any creams or lotions on the treated area. This could interfere with treatment. (C) Radiation therapy clients should wear loose-fitting clothes and avoid tight, irritating fabrics. (D) The area of skin being treated is sensitive to sunlight, and the client should take care to prevent sun damage by avoiding direct sunlight and covering the area when she is in the sun.