NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 661:

  During his hospitalization, a 3-year-old child has become unusually aggressive in his play activities. His parents report this change in behavior to the primary nurse. How could the nurse explain the child's change in behavior?

  A. Deep-seated feelings of hostility
  B. A lack of interest in socializing
  C. Usual behavior for this child
  D. A coping response
  D. A coping response

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  (A) Unusually aggressive behavior does not indicate a deepseated problem. (B) A lack of social interest results in poor participation in play activities with peers. Aggression would not be an expected behavior. (C) The aggressive behavior was newly developed and not a routine behavior. (D) Play provides the child with opportunities for coping and adaptation. Aggression during the play activities would indicate a coping response.

• Question 662:

  A mother continues to breast-feed her 3-month-old infant. She tells the nurse that over the past 3 days she has not been producing enough milk to satisfy the infant. The nurse advises the mother to do which of the following?

  A. "Start the child on solid food."
  B. "Nurse the child more frequently during this growth spurt."
  C. "Provide supplements for the child between breastfeeding so you will have enough milk."
  D. "Wait 4 hours between feedings so that your breasts will fill up."
  B. "Nurse the child more frequently during this growth spurt."

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  (A) Solid foods introduced before 4? months of age are not compatible with the abilities of the GI tract and the nutritional needs of the infant. (B) Production of milk is supply and demand. A common growth spurt occurs at 3 months of age, and more frequent nursing will increase the milk supply to satisfy the infant. (C) Supplementation will decrease the infant's appetite and in turn decrease the milk supply. When the infant nurses less often or with less vigor, the amount of milk produced decreases. (D) Rigid feeding schedules lead to a decreased milk supply, whereas frequent nursing signals the mother's body to produce a correspondingly increased amount of milk.

• Question 663:

  A client has been in labor 10 hours and is becoming very tired. She has dilated to 7 cm and is at 0 station with the fetus in a right occipitoposterior position. She is complaining of severe backache with each contraction. One comfort measure the nurse can employ is to:

  A. Place her in knee-chest position during the contraction
  B. Use effleurage during the contraction
  C. Apply strong sacral pressure during the contraction
  D. Have her push with each contraction
  C. Apply strong sacral pressure during the contraction

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  (A) This measure is inappropriate. The knee-chest position is employed to take pressure off the cord. (B) Effleurage is a comfort measure but not the one that will contribute most to the relief of backache caused by a posterior position. (C) Sacral pressure will counteract the pressure created by the position of the fetal head. (D) The client is not completely dilated. Pushing is contraindicated until the second stage of labor.

• Question 664:

  A female client at 36 weeks' gestation is experiencing preterm labor. Her physician has prescribed two doses of betamethasone 12 mg IM q24h. The nurse explains that she is receiving this drug to:

  A. Treat fetal respiratory distress syndrome
  B. Prevent uterine infection
  C. Promote fetal lung maturation
  D. Increase uteroplacental circulation
  C. Promote fetal lung maturation

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  (A) Respiratory distress syndrome occurs in the newborn, not the fetus. It may be treated postnatally with surfactant therapy. (B) Betamethasone is a corticosteroid, not an anti- infective drug; therefore, its use would not prevent uterine infection. (C) Betamethasone binds with glucocorticoid receptors in alveolar cells to increase production of surfactant, thus increasing lung maturity in the preterm fetus. (D) Betamethasone does not affect uteroplacental circulatory exchange.

• Question 665:

  A male client is started on IV anticoagulant therapy with heparin. Which of the following laboratory studies will be ordered to monitor the therapeutic effects of heparin?

  A. Partial thromboplastin time
  B. Hemoglobin
  C. Red blood cell (RBC) count
  D. Prothrombin time
  A. Partial thromboplastin time

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  (A)

  Partial thromboplastin time is used to monitor the effects of heparin, and dosage is adjusted depending on test results. It is a screening test used to detect deficiencies in all plasma clotting factors except factors VII and XIII and platelets.

  (B)

  Hemoglobin is the main component of RBCs. Its main function is to carry O2from the lungs to the body tissues and to transport CO2back to the lungs. (C) RBC count is the determination of the number of RBCs found in each cubic millimeter of whole blood. (D) PT is used to monitor the effects of oral anticoagulants, e.g., coumarintype anticoagulants.

• Question 666:

  In working with a manipulative client, which of the following nursing interventions would be most appropriate?

  A. Bargaining with the client as a strategy to control the behavior
  B. Redirecting the client
  C. Providing a consistent set of guidelines and rules
  D. Assigning the client to different staff persons each day
  C. Providing a consistent set of guidelines and rules

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  (A) This answer is incorrect. Bargaining is a manipulative act, which the nurse could expect from the client. (B) This answer is incorrect. Confrontation is an effective nursing strategy with manipulative behavior. Redirection is appropriate for the client who is out of touch with reality. (C) This answer is correct. Manipulative clients must abide by consistent rules. (D) This answer is incorrect. Manipulation is kept at a minimum if the same staff person is assigned to the client. Often the client will attempt to play staff persons against each other.

• Question 667:

  A 14-year-old client has a history of lying, stealing, and destruction of property. Personal items of peers have been found missing. After group therapy, a peer approaches the nurse to report that he has seen the 14- year-old with some of the missing items. The best response of the nurse is to:

  A. Request that he explain to the group why he took personal items from peers
  B. Approach him when he is alone to inquire about his involvement in the incident
  C. Imply to him that you doubt his involvement in the incident and request his denial
  D. Confront him openly in group and request an apology
  B. Approach him when he is alone to inquire about his involvement in the incident

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  (A) This answer is incorrect. There is no proof that he removed the missing items. (B) This answer is correct. Anxiety and defensiveness are lessened if the individual is approached in this manner. (C) This answer is incorrect. It is difficult for one to admit to wrongdoing with this approach. (D) This answer is incorrect. He has not yet been proved guilty. Confrontation will only increase defensiveness and anxiety.

• Question 668:

  A mother brings her 3-year-old child who is unconscious but breathing to the ER with an apparent drug overdose. The mother found an empty bottle of aspirin next to her child in the bathroom. Which nursing action is the most appropriate?

  A. Put in a nasogastric tube and lavage the child's stomach.
  B. Monitor muscular status.
  C. Teach mother poison prevention techniques.
  D. Place child on respiratory assistance.
  A. Put in a nasogastric tube and lavage the child's stomach.

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  (A) The immediate treatment for drug overdose is removal of the drug from the stomach by either forced emesis or gastric lavage. The child's unconscious state prohibits forced emesis. (B) Toxic amounts of salicylates directly affect the respiratory system, which could lead to respiratory failure. (C) The mother's anxiety is probably so high that preventive guidance will be ineffective. (D) Respiratory assistance is not needed if the child's respiratory function is unaltered.

• Question 669:

  A male infant is to be discharged home this morning. Which instruction related to his cord care should be included in his mother's discharge teaching plan?

  A. Keep the umbilical area moist with Vaseline until the stump falls off.
  B. Keep the umbilical area covered at all times with the diaper.
  C. Clean the umbilical cord with alcohol at each diaper change.
  D. Clean the umbilical cord daily with soap and water during the bath.
  C. Clean the umbilical cord with alcohol at each diaper change.

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  (A) The umbilical area should be kept dry for healing to occur. Moisture is conducive to bacterial growth and therefore could lead to infection at the site. (B) The diaper should be folded below the cord to allow the cord stump to be exposed to the air for healing. (C) The umbilical cord should be swabbed with alcohol at each diaper change to remove urine and stool and to facilitate the desiccation process through drying. (D) Soap and water should not be used to clean the umbilical area because the area could retain moisture, thus making it susceptible to bacterial growth and infection.

• Question 670:

  After 3 weeks of treatment, a severely depressed client suddenly begins to feel better and starts interacting appropriately with other clients and staff. The nurse knows that this client has an increased risk for:

  A. Suicide
  B. Exacerbation of depressive symptoms
  C. Violence toward others
  D. Psychotic behavior
  A. Suicide

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  (A) When the severely depressed client suddenly begins to feel better, it often indicates that the client has made the decision to kill himself or herself and has developed a plan to do so. (B) Improvement in behavior is not indicative of an exacerbation of depressive symptoms. (C) Thedepressed client has a tendency for self-violence, not violence toward others. (D) Depressive behavior is not always accompanied by psychotic behavior.