NCLEX-RN
NCLEX RN Nursing Exam Questions
Extract:
Question 1 of 5
A 24-year-old client presents to the emergency department protesting 'I am God.' The nurse identifies this as a:
Correct Answer: A
Rationale: A delusion is a false belief, such as claiming to be God, common in psychotic disorders.
Question 2 of 5
The nurse is caring for a client with a history of Raynaud’s disease. The nurse should expect the client to have:
Correct Answer: A
Rationale: Raynaud’s disease causes vasospasms, leading to color changes (white, blue, red) in the fingers triggered by cold or stress.
Question 3 of 5
The nurse is caring for a client with a diagnosis of postpartum endometritis. Which vital sign change is most characteristic?
Correct Answer: A
Rationale: Fever is the most characteristic vital sign change in postpartum endometritis reflecting the underlying uterine infection. Tachycardia and hypotension occur only in severe cases.
Question 4 of 5
The client with a history of seizures is prescribed phenytoin (Dilantin). Which instruction should the nurse include in the teaching plan?
Correct Answer: B
Rationale: Alcohol can interact with phenytoin, increasing toxicity or reducing efficacy, so it should be avoided. Milk does not prevent GI upset, stopping medication requires physician guidance, and extra doses are dangerous.
Question 5 of 5
A psychiatric client has been stabilized and is to be discharged. The nurse will recognize client insight and behavioral change by which of the following client statements?
Correct Answer: A
Rationale: The client verbalizes that he is responsible for compliance and keeping the treatment team member informed of progress. This behavior puts him at the lowest risk for relapse. Noncompliance is a major cause of relapse. This statement reflects lack of responsibility for his own health maintenance. This statement reflects lack of insight into the importance of compliance. This statement reflects no insight into his illness or his responsibility in health maintenance.