NCLEX Questions, NCLEX RN Predictor Exam Questions, NCLEX-RN

Extract:

Question 1 of 5

A 79-year-old client with Alzheimer's disease is exhibiting significant memory impairment, cognitive impairment, extremely impaired judgment in social situations, and agitation when placed in a new situation or around unfamiliar people. The nurse should include the following strategy in the client's care:

Correct Answer: A

Rationale: Alzheimer's clients cope poorly with changes in routine because of memory deficits. Schedule changes cause confusion and frustration, whereas adhering to schedules is helpful and supports orientation. Insisting that the client go to all unit activities may antagonize her and increase her agitation because of cognitive impairments. It may be better to allow the client time for calming down or distraction rather than to insist that she attend every activity. When repeating a question, allow time first for a response; then use the same words the second time to avoid further confusion. The nurse should avoid giving several choices at once. Cognitively impaired clients will become more frustrated with making decisions.

Question 2 of 5

A client was not using his seat belt when involved in a car accident. He fractured ribs 5, 6, and 7 on the left and developed a left pneumothorax. Assessment findings include:

A. Crackles and paradoxical chest wall movement B. Decreased breath sounds on the left and chest pain with movement C. Rhonchi and frothy sputum D. Wheezing and dry cough

Correct Answer: B

Rationale: A pneumothorax causes collapsed lung tissue, leading to decreased breath sounds, and rib fractures cause chest pain with movement.

Question 3 of 5

Assessment of a newborn for Apgar scoring includes observation for:

A. Pupil response B. Respiratory rate C. Heart rate D. Babinski's reflex

Correct Answer: C

Rationale: Heart rate is a critical component of Apgar scoring, assessed at 1 and 5 minutes to evaluate newborn vitality.

Question 4 of 5

A pregnant woman at 36 weeks' gestation is followed for PIH and develops proteinuria. To increase protein in her diet, which of the following foods will provide the greatest amount of protein when added to her intake of 100 mL of milk?

A. Fifty milliliters light cream and 2 tbsp corn syrup B. Thirty grams powdered skim milk and 1 egg C. One small scoop (90 g) vanilla ice cream and 1 tbsp chocolate syrup D. One package vitamin-fortified gelatin drink

Correct Answer: B

Rationale: This choice would provide more unwanted fat and sugar than protein. Skim milk would add protein. Eggs are good sources of protein while low in fat and calories. The benefit of protein from ice cream would be outweighed by the fat content. Chocolate syrup has caffeine, which is contraindicated or limited in pregnancy. Although most animal proteins are higher in protein than plant proteins, gelatin is not. It loses protein during the processing for food consumption.

Question 5 of 5

A 68-year-old man was recently diagnosed with endstage renal disease. He has not yet begun dialysis but is experiencing severe anemia with associated symptoms of dyspnea on exertion and chest pain. Which statement best describes the management of anemia in renal failure?

A. Hematocrit levels usually remain slightly below normal in clients with renal failure. B. Transfusion is often begun as early as possible to prevent complications of anemia such as dyspnea and angina. C. Anemia in renal failure is frequently caused by low serum iron and ferritin and corrected by oral iron and ferritin replacement therapy. D. The renal secretion of erythropoiesis is decreased. The bone marrow requires erythropoietin to mature red blood cells.

Correct Answer: D

Rationale: Clients in renal failure typically have very low hematocrits, often in the range of 16-22%. Transfusion is avoided unless the client exhibits acute symptoms such as dyspnea, chest pain, tachycardia, and extreme fatigue. When the client is given a transfusion, the bone marrow adjusts by producing less red blood cells. Anemia in renal failure is caused primarily by decreased erythropoietin. Low serum iron and ferritin may aggravate the anemia and require treatment. Decreased secretion of erythropoietin by the kidney is the primary cause of anemia. The bone marrow requires this hormone to mature red blood cells. Treatment is with replacement therapy.