NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
A 48-hour-old male infant is ordered to have phototherapy. When his mother questions the nurse about its purpose, the nurse explains that phototherapy:
Correct Answer: C
Rationale: The instillation of erythromycin ophthalmic preparation, not phototherapy, prevents ophthalmia neonatorum. The administration of vitamin K (AquaMEPHYTON) assists the infant's clotting mechanism. Excessive bilirubin accumulates when the infant's liver cannot handle the increased load caused by the breakdown of red blood cells postnatally. This excessive bilirubin seeps out of the blood and into the tissues, staining them yellow. Phototherapy accelerates the removal of bilirubin from the skin by breaking it down into substances that can be excreted in stool or urine. Phototherapy decreases levels of unconjugated bilirubin, thereby preventing kernicterus.
Question 2 of 5
The nurse is caring for a client with an endemic goiter. The nurse recognizes that the client's condition is related to:
Correct Answer: A
Rationale: Endemic goiter results from iodine deficiency, often in areas with iodine-depleted soil, leading to insufficient thyroid hormone production.
Question 3 of 5
A 20-year-old male client is being treated for protein deficiency. If he likes all of the following foods, which one would the nurse recommend to increase in the diet?
Correct Answer: C
Rationale: Cantaloupe is a good source of carbohydrates, vitamin C, and vitamin A. Rice contains about 4 g of protein per 200 g. Chicken contains 35 g protein per breast. Chicken is a rich source of vitamin B6 (pyridoxine), which is needed for adequate protein synthesis. As protein intake increases, vitamin B6 intake must also be increased. Vitamin B6 is a coenzyme in amino acid metabolism. Green beans only contain 2 g of protein per cup.
Question 4 of 5
The nurse is caring for a client hospitalized with a facial stroke. Which diet selection would be suited to the client?
Correct Answer: B
Rationale: A facial stroke may impair chewing and swallowing. Soft foods like split pea soup mashed potatoes and pudding are easier to swallow and safer for a client with dysphagia. The other options include harder or chewier foods that pose a risk.
Question 5 of 5
A 60-year-old male client was hospitalized 3 days ago with the diagnosis of acute anterior wall myocardial infarction. Today he has been complaining of increasing weakness and shortness of breath. Crackles in both lung bases are audible on auscultation. He is developing:
Correct Answer: C
Rationale: Anterior wall myocardial infarction increases the risk of left ventricular failure, leading to pulmonary edema, characterized by weakness, shortness of breath, and crackles.