NCLEX-RN
NCLEX RN Predictor Exam Questions
Extract:
Question 1 of 5
Newborns are routinely screened for phenylketonuria. The nursery nurse ensures that this screening test is performed:
Correct Answer: B
Rationale: The infant has not ingested any protein immediately after birth, which is necessary to detect excessive serum phenylalanine. It is important that the infant take in 2-3 full days of milk or formula feedings to preclude a false-negative reading. At 2-3 days of age, inadequate milk could have been ingested owing to a delay in the initial feeding. The biochemical buildup of serum phenylalanine is detectable after 2-3 days of milk or formula ingestion.
Question 2 of 5
The nurse will be alert to the most potentially life-threatening side effect associated with the administration of monoamine oxidase (MAO) inhibitor. This is:
Correct Answer: B
Rationale: Oculogyric crisis, involuntary upward deviation and fixation of the eyeballs, is usually associated with either postencephalitic parkinsonian or drug-induced extrapyramidal symptoms (EPS). Hypertensive crisis is a potentially life-threatening side effect. This may occur if the client ingests foods, beverages, or medications containing tyramine. Orthostatic hypotension, a drop in blood pressure resulting from a rapid change of body position, can occur with the administration of antidepressants. Tardive dyskinesia, characterized by slow, rhythmical, automatic or stereotyped muscular movements, usually is associated with the administration of certain antipsychotic medications.
Question 3 of 5
A female client at 10 weeks' gestation complains to her physician of slight vaginal bleeding and mild cramps. On examination, her physician determines that her cervix is closed. The client is exhibiting signs of:
Correct Answer: B
Rationale: An inevitable abortion includes the signs of cervical dilation and effacement as well as pain and bleeding. A threatened abortion is a condition in which intrauterine bleeding occurs early in pregnancy, the cervix remains undilated, and the uterine contents are not necessarily expelled. An incomplete abortion occurs when some portions of the products of conception are expelled from the uterus. A missed abortion occurs when the embryo dies in utero and is retained in the uterus.
Question 4 of 5
A four-year-old is admitted with acute leukemia. It will be most important to monitor the child for:
Correct Answer: C
Rationale: Acute leukemia causes bone marrow suppression, leading to bleeding (from low platelets) and pallor (from anemia). These are critical signs to monitor. Other symptoms are less immediate.
Question 5 of 5
The nurse is assessing the circulation of a patient in a long leg cast. Which of the following assessments indicate adequate circulation to the extremity?
Correct Answer: D
Rationale: Brisk capillary refill of less than three seconds indicates adequate blood flow to the extremity as it shows that blood is returning quickly to the capillaries after compression. While the other options (no pain toe movement and sensation) are positive signs they do not directly assess circulation as effectively as capillary refill.