NCLEX Questions, NCLEX-RN Exam Practice Questions, NCLEX-RN Questions, Nurselytic

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Question 1 of 5

A behavioral modification program is recommended by the multidisciplinary team working with a 15-year-old client with anorexia nervosa. A nursing plan of care based on this modality would include:

Correct Answer: B

Rationale: This answer is incorrect. Role playing is based on learning but is not based on the behavioral modification model. This answer is correct. The behavioral modification model is based on negative and positive reinforcers to change behavior. This answer is incorrect. Verbal catharsis is not an intervention based on behavioral modification. This answer is incorrect. Although an acceptable nursing intervention, it is not based on behavioral modification.

Question 2 of 5

When the nurse checks the fundus of a client on the first postpartum day,she notes that the fundus is firm level with the umbilicus and displaced to the side. The next action the nurse should take is to:

Correct Answer: A

Rationale: A displaced fundus on the first postpartum day is often due to bladder distention which pushes the uterus aside. Checking for bladder distention (e.g. by palpation or encouraging voiding) is the next step to correct the displacement.

Question 3 of 5

A female client has been diagnosed with chronic renal failure. She is a candidate for either peritoneal dialysis or hemodialysis and must make a choice between the two. Which information should the nurse give her to help her decide?

Correct Answer: A

Rationale: Hemodialysis is faster in clearing the blood of toxins than peritoneal dialysis. However, clients must consider the time that they spend traveling to the dialysis center and the disruption in their daily lives. Peritoneal dialysis requires several exchanges with dwelling time for the dialysate and therefore takes longer than hemodialysis. Several serious complications of peritoneal dialysis include peritonitis, catheter displacement and/or plugging, or pain during dialysis. A client can be taught to self-administer peritoneal dialysis without the aid of a professional.

Question 4 of 5

A 48-year-old male client is hospitalized with mild ascites, bruising, and jaundice. He has a 20-year history of alcohol abuse. The client is diagnosed with cirrhosis. His serum ammonia level is high, indicating hepatic encephalopathy. He has esophageal varices. Which of the following may cause the varices to rupture?

Correct Answer: A

Rationale: Lifting heavy objects will increase intrathoracic pressure, thus placing the client at risk for rupturing esophageal varices.

Question 5 of 5

One of the most important criteria for the diagnosis of physical abuse is inconsistency between the appearance of the injury and the history of how the injury occurred. Which one of the following situations should alert the nurse to the possibility of abuse?

Correct Answer: A

Rationale: Sock and mitten burns (circumferential burns on hands and feet) are suggestive of immersion in hot water, inconsistent with a simple fall, raising suspicion of abuse.

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