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Questions 158

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NCLEX RN Nursing Exam Questions

Extract:


Question 1 of 5

An 83-year-old client has been hospitalized following a fall in his home. He has developed a possible fecal impaction. Which of the following assessment findings would be most indicative of a fecal impaction?

Correct Answer: C

Rationale: Liquid stool can pass around an impaction, making it a key indicator. The other findings are not specific to fecal impaction.

Question 2 of 5

A husband and wife and their two children, age 9 and age 5, are requesting family therapy. Which of the following strategies is most therapeutic for the nurse to use during the initial interaction with a family?

Correct Answer: D

Rationale: Allowing family members to choose their own seats will assist the nurse in assessing the family system and in determining who feels closer to whom.

Question 3 of 5

A child with celiac disease is being discharged from the hospital. The mother demonstrates knowledge of nutritional needs of her child when she is able to state the foods which are included in a:

Correct Answer: B

Rationale: A lactose-restricted diet is prescribed for children with lactose intolerance or diarrhea. A gluten-restricted diet is the diet for children with celiac disease. A phenylalanine-restricted diet is prescribed for children with phenylketonuria. A fat-restricted diet is prescribed for children with disorders of the liver, gallbladder, or pancreas.

Question 4 of 5

A burn client's care plan reveals an expected outcome of no localized or systemic infection. Which assessment by the nurse supports this outcome?

Correct Answer: A

Rationale: Minimal bacteria in wound cultures indicates no localized infection, supporting the outcome. Cloudy urine (
B), elevated WBC (
C), and fever (
D) suggest possible infection.

Question 5 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.

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