NCLEX-RN Free Study Guide! with New Update 865 Exam Questions
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Discuss the key features of the exam.
There are several key features of the exam:
You are tested on how you would use critical thinking skills.
Essay Test: The essay test is an important component of the NCLEX-RN exam. The question is designed to test your ability to analyze situations and determine the best course of action. This is similar to the way you were trained during nursing school.
It also tests your ability to make nursing judgments.
It tests if you understand the basics of the nursing process.
Reading Comprehension Test: The reading comprehension test consists of 120 multiple choice questions. You have three-and-a-half hours to complete this section.
NEW QUESTION 186
When inspecting a cardiovascular client, the nurse notes that he needs to sit upright to breathe. This behavior is most indicative of:
- A. Congestive heart failure
- B. Anxiety
- C. Pericarditis
- D. Angina
Answer: A
Explanation:
(A) Pericarditis can cause dyspnea but primarily causes chest pain. (B) Anxiety can cause dyspnea resulting in SOB, yet it is not typically influenced by degree of head elevation. (C) The inability to oxygenate well without being upright is most indicative of congestive heart failure, due to alveolar drowning. (D) Angina causes primarily chest pain; any SOB associated with angina is not influenced by body position.
NEW QUESTION 187
An elective saline abortion has been performed on a 3-week primigravida. Following the procedure, the nurse should be alert for which early side effect?
- A. Thirst
- B. Water satiety
- C. Diabetes insipidus
- D. Edema
Answer: A
Explanation:
Section: Questions Set C
Explanation:
(A) If the client is experiencing water satiety, there is no more desire for water. (B) Absorption of saline into circulation rather than into amniotic sac increases serum sodium and desire for water. (C) Edema can be a late side effect caused by water intoxication. (D) Diabetes insipidus occurs as a result of deficient antidiuretic hormone.
NEW QUESTION 188
A client is a victim of domestic violence. She is now receiving assistance at a shelter for battered women. She tells the nurse about the cycle of violence that she has been experiencing in her relationship with her husband of 5 years. In the "tension-building phase," the nurse might expect the client to describe which of the following?
- A. A period of tenderness between the couple
- B. Acute battering of the client, characterized by his volatile discharge of tension
- C. Minor battering incidents, such as the throwing of food or dishes at her
- D. Promises of gifts that her husband made to her
Answer: C
Explanation:
Explanation
(A) This description is characteristic of the "honeymoon" or "respite" phase. (B) This description is characteristic of the "battering" phase. (C) This description is characteristic of the "tension- building" phase prior to the volatile discharge of tension found in the battering phase. (D) This description is characteristic of the "honeymoon" or "respite" phase.
NEW QUESTION 189
A child is admitted with severe headache, fever, vomiting, photophobia, drowsiness, and stiff neck associated with viral meningitis. She will be more comfortable if the nurse:
- A. Encourages her to breathe slowly and deeply
- B. Places a large, soft pillow under her head
- C. Offers sips of warm liquids
- D. Dims the lights in her room
Answer: D
Explanation:
Explanation
(A) The discomfort of photophobia is alleviated by dimming the lights. (B) Helping the child to breathe slowly and deeply may help to reduce anxiety, but it will not alleviate other discomforts of viral meningitis. (C) It is important to maintain fluid balance, but sips of warm liquids do not alleviate the discomforts of meningitis.
(D) A large, soft pillow under her head causing neck flexion is likely to increase her discomfort owing to stretching of the meninges.
NEW QUESTION 190
Cystic fibrosis is transmitted as an autosomal recessive trait. This means that:
- A. Mothers carry the gene and pass it to their sons
- B. Fathers carry the gene and pass it to their daughters
- C. Both parents must have the disease for a child to have the disease
- D. Both parents must be carriers for a child to have the disease
Answer: D
Explanation:
Section: Questions Set G
Explanation:
(A) Cystic fibrosis is not an X-linked or sex-linked disease. (B) The only characteristic on the Y chromosome is the trait for hairy ears. (C) Both parents do not need to have the disease but must be carriers. (D) If a trait is recessive, two genes (one from each parent) are necessary to produce an affected child.
NEW QUESTION 191
A client in active labor asks the nurse for coaching with her breathing during contractions. The client has attended Lamaze birth preparation classes. Which of the following is the best response by the nurse?
- A. "Make sure you take a deep cleansing breath as the contractions start, focus on an object, and breathe about 16-20 times a minute with shallow chest breaths."
- B. "Find a comfortable position before you start a contraction. Once the contraction has started, take slow breaths using your abdominal muscles."
- C. "Keep breathing with your abdominal muscles as long as you can."
- D. "If a woman in labor listens to her body and takes rapid, deep breaths, she will be able to deal with her contractions quite well."
Answer: A
Explanation:
Explanation
(A) Lamaze childbirth preparation teaches the use of chest, not abdominal, breathing. (B) In Lamaze preparation, every patterned breath is preceded by a cleansing breath; as labor progresses, shallow, paced breathing is found to be effective. (C) It is important to assume a comfortable position in labor, but the Lamazeprepared laboring woman is taught to breathe with her chest, not abdominal, muscles. (D) When deep chest breathing patterns are used in Lamaze preparation, they are slowly paced at a rate of 6-9 breaths/min.
NEW QUESTION 192
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. Bleeding time of 4 minutes
- B. White blood cell (WBC) count 10,000 WBCs/mm3
- C. pH 7.39
- D. Hematocrit 60%
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Normal pH of arterial blood gases for an infant is 7.35-7.45. (B) Normal white blood cell count in an infant is 6,000-17,500 WBCs/mm3. (C) Normal hematocrit in infant is 28%-42%. A 60% hematocrit may indicate polycythemia, a common complication of cyanotic heart disease. (D) Normal bleeding time is 2-7 minutes.
NEW QUESTION 193
The nurse is caring for a 3-month-old girl with meningitis. She has a positive Kernig's sign. The nurse expects her to react to discomfort if she:
- A. Plantiflexes her wrist
- B. Turns her head to the side
- C. Flexes her spine
- D. Dorsiflexes her ankle
Answer: C
Explanation:
(A) Discomfort with ankle dorsiflexion is not expected with meningitis. (B) Spinal flexion, flexing the neck or the hips with legs extended, causes discomfort if the meninges are irritated. (C) Discomfort with wrist flexion is not expected with meningitis. (D) Rotating the cervical spine may cause discomfort with meningitis, but pain with flexion is more indicative of meningeal irritation.
NEW QUESTION 194
MgSO4 blood levels are monitored and the nurse would be prepared to administer the following antidote for MgSO4 side effects or toxicity:
- A. Calcium gluconate
- B. Naloxone (Narcan)
- C. Calcium hydroxide
- D. Magnesium oxide
Answer: A
Explanation:
Explanation
(A, B) These drugs are not antidotes for MgSO4. (C) This drug is the standard antidote and should always be readily available when MgSO4is being administered. (D) This drug is an antidote for narcotics, not MgSO4.
NEW QUESTION 195
A 12-year-old girl has been diagnosed with insulindependent diabetes mellitus. Which of these principles would best guide her nutritional management?
- A. Caloric distribution should be calculated to fit activity patterns.
- B. Concentrated sweets are taken during increased activity.
- C. Fat requirements are increased owing to the possibility of ketoacidosis.
- D. Food restriction is imposed to reduce weight.
Answer: A
Explanation:
(A) Concentrated sweets are eliminated from diet planning. Complex carbohydrates may be taken at the time of increased activity. (B) Food restriction is not used for diabetic control of growing children. Caloric restriction may be imposed for weight control if necessary. (C) Total caloric intake and proportions of basic nutrients should be consistent from day to day. Distribution of these calories should fit the activity pattern. Extra food is needed for increased activity. A balance of food, exercise, and insulin should be maintained. (D) Because of the increased risk of atherosclerosis, the fat percentage of the total caloric intake is reduced.
NEW QUESTION 196
A client delivered her first-born son 4 hours ago. She asks the nurse what the white cheeselike substance is under the baby's arms. The nurse should respond:
- A. "Let me have a closer look at it. The baby may have an infection."
- B. "This material, called vernix, covered the baby before it was born. It will disappear in a few days."
- C. "This is a normal skin variation in newborns. It will go away in a few days."
- D. "Babies sometimes have sebaceous glands that get plugged at birth. This substance is an example of that condition."
Answer: B
Explanation:
(A) This response identifies the fact that vernix is a normal neonatal variation, but it does not teach the client medical terms that may be useful in understanding other healthcare personnel. (B) This response may raise maternal anxiety and incorrectly identifies a normal neonatal variation. (C) This response correctly identifies this neonatal variation and helps the client to understand medical terms as well as the characteristics of her newborn. (D) Blocked sebaceous glands produce milia, particularly present on the nose.
NEW QUESTION 197
A client is resting comfortably after delivering her first child. When assessing her pulse rate, the nurse would recognize the following finding to be typical:
- A. Thready pulse
- B. Irregular pulse
- C. Tachycardia
- D. Bradycardia
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) A thready pulse is indicative of hypotension and excessive blood loss and is often rapid. (B) Pulse irregularities or dysrhythmias do not occur in the normal postpartal woman. (C) Tachycardia occurs less frequently than bradycardia and is related to increased blood loss or prolonged difficult labor and/or birth.
(D) Puerperal bradycardia with rates of 50-70 bpm commonly occurs during the first 6-10 days of the postpartal period. It may be related to decreased cardiac strain, decreased blood volume, contraction of the uterus, and increased stroke volume.
NEW QUESTION 198
At her monthly prenatal visit, a client reports experiencing heartburn. Which nursing measure should be included in her plan of care to help alleviate it?
- A. Lie down after eating.
- B. Restrict fluid intake.
- C. Use Alka-Seltzer as necessary.
- D. Eat small, frequent bland meals.
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) At least eight glasses of fluid per day are encouraged to help dilute stomach contents, thereby decreasing irritation. (B) Alka Seltzer contains aspirin, which is irritating to gastric mucosa, and therefore should be avoided. (C) Small, frequent bland meals help to decrease gastric pressure and to prevent reflux. (D) Lying down after meals may cause gastric reflux and prevents optimal gastric emptying.
NEW QUESTION 199
A client diagnosed with severe anemia is to receive 2 U of packed red blood cells. Prior to starting the blood transfusion, the nurse must:
- A. Take a baseline set of vital signs
- B. Have the registered nurse in charge assume responsibility for verifying the client and blood product information
- C. Hang Ringer's lactate as the companion fluid
- D. Use microdrip tubing for the blood administration
Answer: A
Explanation:
Explanation
(A) A baseline set of vital signs is necessary to determine if any transfusion reactions occur as the blood product is being administered. (B) The only companion fluid to be used during a blood transfusion is normal saline. The calcium in Ringer's lactate can cause clotting. (C) Only a blood administration set should be used.
A microdrip tube would cause lysis of the red blood cells. (D) Proper identification of the recipient and the blood product must be validated by at least two people.
NEW QUESTION 200
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 eat red meat?"
- B. "Have your stools been normal?"
- C. "Do you drink alcohol on a regular basis?"
- D. "Do you take aspirin on a regular basis?"
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(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.
NEW QUESTION 201
Clinical manifestations seen in left-sided rather than in right-sided heart failure are:
- A. Hypotension and hepatomegaly
- B. Decreased peripheral perfusion and rales
- C. Dyspnea and jaundice
- D. Elevated central venous pressure and peripheral edema
Answer: B
Explanation:
(A, B, C) Clinical manifestations of right-sided heart failure are weakness, peripheral edema, jugular venous distention, hepatomegaly, jaundice, and elevated central venous pressure. (D) Clinical manifestations of left-sided heart failure are left ventricular dysfunction, decreased cardiac output, hypotension, and the backward failure as a result of increased left atrium and pulmonary artery pressures, pulmonary edema, and rales.
NEW QUESTION 202
A 29-year-old client is admitted for a hysterectomy. She has repeatedly told the nurses that she is worried about having this surgery, has not slept well lately, and is afraid that her husband will not find her desirable after the surgery. Shortly into the preoperative teaching, she complains of a tightness in her chest, a feeling of suffocation, lightheadedness, and tingling in her hands. Her respirations are rapid and deep.
Assessment reveals that the client is:
- A. Wanting attention from the nurses
- B. Suffering from complete upper airway obstruction
- C. Hyperventilating
- D. Having a heart attack
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) Classic symptoms of a heart attack include heaviness or squeezing pain in the chest, pain spreading to the jaw, neck, and arm. Nausea and vomiting, sweating, and shortness of breath may be present. The client does not exhibit these symptoms. (B) Clients suffering from anxiety or fear prior to surgical procedures may develop hyperventilation. This client is not seeking attention. (C) Symptoms of complete airway obstruction include not being able to speak, and no airflow between the nose and mouth. Breath sounds are absent. (D) Tightness in the chest; a feeling of suffocation; lightheadedness; tingling in the hands; and rapid, deep respirations are signs and symptoms of hyperventilation. This is almost always a manifestation of anxiety.
NEW QUESTION 203
A pregnant client continues to visit the clinic regularly during her pregnancy. During one of her visits while lying supine on the examining table, she tells the RN that she is becoming light-headed. The RN notices that the client has pallor in her face and is perspiring profusely.
The first intervention the RN should initiate is to:
- A. Place the examining table in the Trendelenburg position
- B. Help the client to a sitting position
- C. Assess the client to see if she is having vaginal bleeding
- D. Obtain the client's vital signs immediately
Answer: B
Explanation:
(A) This position would cause the gravid uterus to bear the increased pressure of the vena cava, which could lead to maternal hypotension, in turn causing the client to continue to have pallor and to feel light-headed. (B) This would not be the first intervention the RN should initiate. TheRN should understand the supine position and its effect on the gravid uterus and vena cava. (C) The RN's first intervention should be one that helps to alleviate the client's symptoms. Obtaining her vital signs will not alleviate her symptoms. (D) This would move the gravid uterus off of the client's vena cava, which would alleviate the maternal hypotension that is the cause of her symptoms.
NEW QUESTION 204
For the past several months, an elderly female client with Alzheimer's disease has experienced paranoia; hallucinations; and aggressive, disruptive behavior. The family is utilizing haloperidol as needed to control her behavior. On nursing assessment, you note that the client demonstrates involuntary movements of the tongue and fingers. This may most likely indicate:
- A. Early symptoms of Parkinson's disease
- B. The need to change her medication from haloperidol to another antipsychotic drug to lessen symptoms
- C. A more advanced stage of Alzheimer's disease than previously experienced by the client
- D. Tardive dyskinesia, which may be a side effect of antipsychotic medication
Answer: D
Explanation:
Explanation
(A) Tardive dyskinesia is a common side effect of antipsychotic medications such as haloperidol.
Discontinuing the medication can alleviate symptoms. (B) Although mild tremors are an early sign of Parkinson's disease, haloperidol must be discontinued first and the client further evaluated. (C) These symptoms do not necessarily indicate a more advanced stage of Alzheimer's disease. (D) Most antipsychotic drugs are chemically similar and will produce the same side effects.
NEW QUESTION 205
A 22-year-old client presents with a diagnosis of antisocial personality disorder and a history of using drugs, writing numerous checks with insufficient funds, and stealing. He appears charming and intelligent, and the other clients are impressed and want to be liked by him. The greatest problem that may arise from this situation is that:
- A. He will manipulate the other clients for his own benefit
- B. He may exhibit self-mutilative behavior
- C. He will become delusional and hallucinate as a result of the excess attention given to him by peers
- D. He will cause the other clients to become psychotic
Answer: A
Explanation:
(A) This answer is correct. Persons with antisocial personality disorder typically are very manipulative. (B) This answer is incorrect. The client's behavior cannot cause another person to become psychotic. (C) This answer is incorrect. Psychosis is not a symptom of antisocial personality. One of the criteria for diagnosis of this disorder is that no psychosis be present. In addition, the client would love the attention. (D) This answer is incorrect. Self-mutilative behavior is characteristic of the borderline personality disorder.
NEW QUESTION 206
Discharge teaching for the client who has a total gastrectomy should include which of the following?
- A. Follow-up visits every 3 weeks for the first 6 months
- B. Need to eat three full meals with plenty of fiber per day
- C. B12 injections needed for the rest of the client's life
- D. Need for the client to increase fluid intake to 3000 mL/day
Answer: C
Explanation:
Explanation
(A) There will be no need to increase fluid intake excessively, because dumping syndrome could present a problem. (B) Followup visits every 3 weeks are not a standard recommendation. Follow-up visits will be highly individualized. (C) With removal of the stomach, intrinsic factor will no longer be produced. Intrinsic factor is necessary for vitamin B12 absorption. Parenteral injections of B12 will be needed on a monthly basis for the rest of the person's life. (D) Smaller, more frequent meals, rather than large, bulky meals, are recommended to prevent problems with dumping syndrome.
NEW QUESTION 207
An infant weighing 15 lb has just been treated for severe diarrhea in the hospital. Discharge instructions by the nurse will include maintenance fluid requirements for the pediatric client. Which of the following values best indicates the nurse's understanding of normal fluid requirements for this infant?
- A. 240 mL/day
- B. 330 mL/day
- C. 960 mL/day
- D. 680 mL/day
Answer: D
Explanation:
Section: Questions Set E
Explanation:
(A, C, D) These answers are incorrect. (B) Normal fluid requirement for this pediatric client is based on the fact that 0-10 kg of weight equals 100 mL/kg per day. This infant weighs 15 pounds (6.8 kg). Thus, 100 mL X 6.8
680 mL/day.
NEW QUESTION 208
Following a gastric resection, which of the following actions would the nurse reinforce with the client in order to alleviate the distress from dumping syndrome?
- A. Taking a long walk after meals
- B. Drinking small amounts of liquids with meals
- C. Eating a low-carbohydrate diet
- D. Eating three large meals a day
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) Six small meals are recommended. (B) Liquids after meals increase the time food empties from the stomach. (C) Lying down after meals is recommended to prevent gravity from producing dumping. (D) A low-carbohydrate diet will prevent a hypertonic bolus, which causes dumping.
NEW QUESTION 209
A child has a nursing diagnosis of fluid volume excess related to compromised regulatory mechanisms.
Which of the following nursing interventions is the most accurate measure to include in his care?
- A. Monitor intake and output.
- B. Weigh the child twice daily on the same scale.
- C. Observe for edema.
- D. Check urine specific gravity of each voiding.
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Although all of these interventions are important aspects of care, weight is the most sensitive indicator of fluid balance. (B) Although monitoring intake and output is important, weight is a more accurate indicator of fluid status. (C) Urine specific gravity does not necessarily indicatefluid volume excess. (D) Edema may not be apparent, yet the client may have fluid volume excess.
NEW QUESTION 210
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