NCLEX-RN
NCLEX Practice Test RN Questions
Extract:
Question 1 of 5
A client admitted to the psychiatric unit claims to be the Pope and insists that he will not be kept away from his followers. The most likely explanation for the client's delusion is:
Correct Answer: C
Rationale: Delusions of grandeur, like claiming to be the Pope, often stem from low self-esteem in psychiatric disorders like schizophrenia, compensating for feelings of inadequacy. The other factors are less specific.
Question 2 of 5
A client admitted with a diagnosis of possible myocardial infarction is admitted to the unit from the emergency room. The nurse's first action when admitting the client will be to:
Correct Answer: B
Rationale: Obtaining vital signs is important after connecting the client to the monitor because vital signs should be stable before the client is discharged from the emergency room. All are important, but the first priority is to monitor the client's rhythm. If the client is in severe pain, pain medication should be given after connecting him to the monitor and obtaining vital signs. Completion of the history profile is the least important of the nursing actions.
Question 3 of 5
A hyperactive client is experiencing flight of ideas. The most therapeutic activity for him would be:
Correct Answer: D
Rationale: This activity would allow the client to channel his energy in a positive way, suitable for his hyperactive state and limited attention span.
Question 4 of 5
The nurse is caring for a client who is receiving terbutaline for preterm labor. Which side effect should the nurse monitor for?
Correct Answer: C
Rationale: Terbutaline a beta-agonist tocolytic commonly causes maternal tachycardia due to its stimulatory effects on the cardiovascular system. Maternal bradycardia fetal hypoglycemia and macrosomia are not associated side effects.
Question 5 of 5
In assessing the nature of the stool of a client who has cystic fibrosis, what would the nurse expect to see?
Correct Answer: B
Rationale: Clay-colored stools indicate dysfunction of the liver or biliary tract. In the early stages of cystic fibrosis, fat absorption is primarily affected resulting in fat, foul, frothy, bulky stools. Dark brown stools indicate normal passage through the colon. Blood-tinged stools indicate dysfunction of the gastrointestinal (GI) tract.