NCLEX-RN
NCLEX RN Nursing Exam Questions
Extract:
Question 1 of 5
A 15-year-old primigravida is admitted with a tentative diagnosis of HELLP syndrome. Which laboratory finding is associated with HELLP syndrome?
Correct Answer: D
Rationale: HELLP syndrome (Hemolysis Elevated Liver enzymes Low Platelets) is characterized by elevated liver enzymes reflecting liver damage. Platelet counts are low not elevated and blood glucose and creatinine clearance are not primary features.
Question 2 of 5
A client is being admitted with syndrome of inappropriate diuretic hormone. Which does the nurse expect to observe?
Correct Answer: B,D,E
Rationale: SIADH causes water retention, leading to hyponatremia, which can cause tachycardia (
B), hostility (
D), and muscle weakness (E). Increased thirst (
A) and polyuria (
C) are more associated with diabetes insipidus.
Question 3 of 5
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?
Correct Answer: C
Rationale: Normal hematocrit in infant is 28%-42%. A 60% hematocrit may indicate polycythemia, a common complication of cyanotic heart disease.
Question 4 of 5
Which of the following findings would be abnormal in a postpartal woman?
Correct Answer: D
Rationale: Frequently the mother experiences a shaking chill immediately after delivery, which is related to a nervous response or to vasomotor changes. If not followed by a fever, it is clinically innocuous. The pulse rate during the immediate postpartal period may be low but presents no cause for alarm. The body attempts to adapt to the decreased pressures intra-abdominally as well as from the reduction of blood flow to the vascular bed. Urinary output increases during the early postpartal period (12-24 hours) owing to diuresis. The kidneys must eliminate an estimated 2000-3000 mL of extracellular fluid associated with a normal pregnancy. A temperature of 100.4°F (38°
C) may occur after delivery as a result of exertion and dehydration of labor. However, any temperature greater than 100.4°F needs further investigation to identify any infectious process.
Question 5 of 5
When planning care for the passive-aggressive client, the nurse includes the following goal:
Correct Answer: B
Rationale: Ceasing to use humor and sarcasm is a more appropriate goal, because this client uses these behaviors covertly to express aggression instead of being open with anger. Use of 'I' messages demonstrates proper use of assertive behavior to express anger instead of passive-aggressive behavior. Client is expected to complete share of work in therapeutic community because he has often obstructed other's efforts by failing to do his share. Client has used conveniently forgetting or withholding information as a passive-aggressive behavior, which is not acceptable.