NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 591:

  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
  D. Reddened butterfly shaped rash over the cheeks and nose

  ---

  (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.

• Question 592:

  A client has a history of alcoholism. He is currently diagnosed with cirrhosis of the liver. The nurse would expect him to be on which type of diet?

  A. High protein and high calorie
  B. High calorie and high carbohydrate
  C. Low-fat 2-g sodium diet
  D. High protein and high fat
  B. High calorie and high carbohydrate

  ---

  (A) A high-protein diet is contraindicated in hepatic disease. (B) High carbohydrates provide high-caloric content to prevent tissue catabolism. (C) A low-fat 2-g sodium diet is a cardiac diet; however, a low-fat diet would be beneficial. (D) A high-protein and high-fat diet is contraindicated in hepatic disease.

• Question 593:

  The nurse has been caring for a 16-year-old female who recently experienced date rape. After having had crisis intervention and been hospitalized for 2 weeks, the nurse knows that the client is effectively coping with the rape when she tells the nurse:

  A. "I know it was my fault that it happened, because I shouldn't have been out so late."
  B. "If I had not worn that sexy dress that night, he wouldn't have raped me."
  C. "I know my date just had so much passion he couldn't handle me saying `no.' "
  D. "I know now that it was not my fault, but I want to continue counseling after my discharge."
  D. "I know now that it was not my fault, but I want to continue counseling after my discharge."

  ---

  (A) This response does not show any insight; the client falsely assumes that she is responsible for the rape. (B) The client continues to falsely assume responsibility for the rapist's behavior. (C) The client believes falsely that rape is an act of passion, rather than one of violence, control, and domination. (D) The client has insight into the rape; she does not believe it was her fault and shows good judgment in deciding to continue with counseling after discharge.

• Question 594:

  A pregnant client comes to the office for her first prenatal examination at 10 weeks. She has been pregnant twice before; the first delivery produced a viable baby girl at 39 weeks 3 years ago; the second pregnancy produced a viable baby boy at 36 weeks 2 years ago. Both children are living and well. Using the GTPAL system to record her obstetrical history, the nurse should record:

  A. 3-2-0-0-2
  B. 2-2-0-2-2
  C. 3-1-1-0-2
  D. 2-1-1-0-2
  C. 3-1-1-0-2

  ---

  (A) This answer is an incorrect application of the GTPAL method. One prior pregnancy was a preterm birth at 36 weeks (T =1, P= 1; not T = 2). (B) This answer is an incorrect application of the GTPAL method. The client is currently pregnant for the third time (G = 3, not 2), one prior pregnancy was preterm (T= 1, P= 1; not T= 2), and she has had no prior abortions (A =0). (C) This answer is the correct application of GTPAL method. The client is currently pregnant for the third time (G =3), her first pregnancy ended at term (>37 weeks) (T = 1), her second pregnancy ended preterm 20?3 weeks) (P = 1), she has no history of abortion (A=0), and she has two living children (L = 2). (D) This answer is an incorrect application of the GTPAL method. The client is currently pregnant for the third time (G =3, not 2).

• Question 595:

  A 16-month-old infant is being prepared for tetralogy of Fallot repair. In the nursing assessment, which lab value should elicit further assessment and requires notification of physician?

  A. pH 7.39
  B. White blood cell (WBC) count 10,000 WBCs/mm3
  C. Hematocrit 60%
  D. Bleeding time of 4 minutes
  C. Hematocrit 60%

  ---

  (A) Normal pH of arterial blood gases for an infant is 7.35?.45. (B) Normal white blood cell count in an infant is 6,000?7,500 WBCs/mm3. (C) Normal hematocrit in infant is 28%?2%. A 60% hematocrit may indicate polycythemia, a common complication of cyanotic heart disease. (D) Normal bleeding time is 2? minutes.

• Question 596:

  A measurable outcome criterion in the nursing care of an adolescent with anorexia nervosa would be:

  A. Accepting her present body image
  B. Verbalizing realistic feelings about her body
  C. Having an improved perception of her body image
  D. Exhibiting increased self-esteem
  B. Verbalizing realistic feelings about her body

  ---

  (A) This outcome criterion is inadequate because the term "accepts" is not directly measurable. (B) This outcome criterion is directly measurable because specific goal-related verbalizations can be heard and verified by the nurse. (C) "Improved perception of body image" is not directly measurable and is therefore open to many interpretations. (D) Although long-term goals for the anorexic client should focus on increased self-esteem, this outcome criterion (as stated) does not include specific indicators or behaviors for which to observe.

• Question 597:

  A 55-year-old client is unconscious, and his physician has decided to begin tube feeding him using a smallbore silicone feeding tube (Keofeed, Duo-Tube). After the tube is inserted, the nurse identifies the most reliable way to confirm appropriate placement is to:

  A. Aspirate gastric contents
  B. Auscultate air insufflated through the tube
  C. Obtain a chest x-ray
  D. Place the tip of the tube under water and observe for air bubbles
  C. Obtain a chest x-ray

  ---

  (A) Aspiration of gastric contents is usually a reliable way to verify tube placement. However, if the client has dark respiratory secretions from bleeding, tube feedings could be mistaken for respiratory secretions; in other words, aspirating an empty stomach is less reliable in this instance. In addition, it is common for small-bore feeding tubes to collapse when suction pressure is applied. (B) Insufflation of air into large-bore nasogastric tubes can usually be clearly heard. In small-bore tubes, it is more difficult to hear air, and it is difficult to distinguish between air in the stomach and air in the esophagus. (C) A chest x- ray is the most reliable means to determine placement of small-bore nasogastric tubes. (D) Observing for air bubbles when the tip is held under water is an unreliable means to determine correct tube placement for all types of nasogastric tubes. Air may come from both the respiratory tract and the stomach, and the client who is breathing shallowly may not force air out of the tube into the water.

• Question 598:

  The nurse is admitting a client with folic acid deficiency anemia. Which of the following questions is most important for the nurse to ask the client?

  A. "Do you take aspirin on a regular basis?"
  B. "Do you drink alcohol on a regular basis?"
  C. "Do you eat red meat?"
  D. "Have your stools been normal?"
  B. "Do you drink alcohol on a regular basis?"

  ---

  (A) Aspirin does not affect folic acid absorption. (B) Folic acid deficiency is strongly associated with alcohol abuse. (C) Because folic acid is a coenzyme for single carbon transfer purines, calves liver or other purines are the meat sources. (D) Folic acid does not affect stool character.

• Question 599:

  A client is placed in five-point restraints after exhibiting sudden violence after illegal drug use, and haloperidol (Haldol) 5 mg IM is administered. After 1 hour, his behavior is more subdued, but he tells the nurse, "The devil followed me into this room, I see him standing in the corner with a big knife. When you leave the room, he's going to cut out my heart." The nurse's best response is:

  A. "I know you're feeling frightened right now, but I want you to know that I don't see anyone in the corner."
  B. "You'll probably see strange things for a while until the PCP wears off."
  C. "Try to sleep. When you wake up, the devil will be gone."
  D. "You're probably feeling guilty because you used illegal drugs tonight."
  A. "I know you're feeling frightened right now, but I want you to know that I don't see anyone in the corner."

  ---

  (A) The nurse is the client's link to reality. This response validates the authenticity of the client's experience by casting doubt on his belief and reinforcing reality. (B) Although this statement may be literally correct, it is nontherapeutic because it lacks validation. (C) This response encourages the client to attempt to do something that may be impossible at this time, offers false reassurance, and reinforces delusional content. (D) The nurse is making an incorrect assumption about the client's feelings by offering a nontherapeutic interpretation of the motivation for the client's actions.

• Question 600:

  A client at 6 months' gestation complains of tiredness and dizziness. Her hemoglobin level is 10 g/dL, and her hematocrit value is 32%. Her nutritional intake is assessed as sufficient. The most likely diagnosis is:

  A. Iron-deficiency anemia
  B. Physiological anemia
  C. Fatigue due to stress
  D. No problem indicated
  A. Iron-deficiency anemia

  ---

  (A) This clinical situation is indicative of iron-deficiency anemia because the client has inadequate nutritional intake. Her blood volume is increasing faster than her red blood cell volume. Anemia is present in the second trimester when the hemoglobin level is <10.5 and the hematocrit value falls below 35%. She needs increased iron supplements with follow- up. (B) The client's values are below levels for physiological anemia. (C) The client is fatigued because of a low hemoglobin level. (D) Her hemoglobin level is low and will probably decrease even more when the blood volume peaks at 28 weeks.