NCLEX-RN
NCLEX-RN Exam Questions
Extract:
Question 1 of 5
For the past several months, an elderly female client with Alzheimer's disease has experienced paranoia; hallucinations; and aggressive, disruptive behavior. The family is utilizing haloperidol as needed to control her behavior. On nursing assessment, you note that the client demonstrates involuntary movements of the tongue and fingers. This may most likely indicate:
Correct Answer: A
Rationale: Tardive dyskinesia is a common side effect of antipsychotic medications such as haloperidol. Discontinuing the medication can alleviate symptoms. Although mild tremors are an early sign of Parkinson's disease, haloperidol must be discontinued first and the client further evaluated. These symptoms do not necessarily indicate a more advanced stage of Alzheimer's disease. Most antipsychotic drugs are chemically similar and will produce the same side effects.
Question 2 of 5
A client tells the nurse that she has a history of urinary tract infections. The nurse would do further health teaching if she verbalizes she will:
Correct Answer: D
Rationale: Restricting fluid intake promotes urinary stasis, increasing infection risk. The other options are appropriate preventive measures.
Question 3 of 5
The nurse is assessing a client with suspected hyperthyroidism. Which finding is most consistent with this diagnosis?
Correct Answer: C
Rationale: Tremors are a common sign of hyperthyroidism due to increased metabolic rate and sympathetic activity. Weight gain, bradycardia, and constipation are more typical of hypothyroidism.
Question 4 of 5
One of the most reliable assessment tools for adequacy of fluid resuscitation in burned children is:
Correct Answer: B
Rationale: Blood pressure can remain normotensive in a state of hypovolemia. Capillary refill, alterations in sensorium, and urine output are the most reliable indicators for assessing hydration. Skin turgor is not a reliable indicator for assessing hydration in a burn client. Fluid intake does not indicate adequacy of fluid resuscitation in a burn client.
Question 5 of 5
The client is admitted with a diagnosis of molar pregnancy. Which laboratory test is most likely to be ordered?
Correct Answer: A
Rationale: Serum hCG levels are markedly elevated in molar pregnancy and are the primary test for diagnosis and monitoring. CBC and urinalysis may be ordered for general assessment but are less specific.