NCLEX Questions, NCLEX RN Nursing Exam Questions, NCLEX-RN Questions, Nurselytic

Questions 158

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NCLEX RN Nursing Exam Questions

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Question 1 of 5

The client is diagnosed with a pneumothorax. Which finding is most expected on auscultation?

Correct Answer: B

Rationale: A pneumothorax causes collapsed lung tissue, resulting in diminished or absent breath sounds on the affected side. Crackles, wheezing, and rhonchi are not typical.

Question 2 of 5

A 42-year-old client presents with a diagnosis of paranoid schizophrenia. She has become increasingly restless and verbally argumentative, and her speech has become pressured. She is exhibiting signs of:

Correct Answer: B

Rationale: Signs of depression would include withdrawal, sadness, morbid thoughts, insomnia, early awakening, etc. These clinical features are classic signs of agitation. Psychotic ideation includes delusional thoughts, bizarre behavior, disorganized thinking, etc. Anhedonia is the inability to experience pleasure.

Question 3 of 5

A client sustained second- and third-degree burns to his face, neck, and upper chest. Which of the following nursing diagnoses would be given the highest priority in the first 8 hours' postburn?

Correct Answer: D

Rationale: Alteration in airway integrity is the highest priority for this client in the first 8 hours postburn. Failure to continually assess this client's airway status could result in poor ventilation and oxygenation, in addition to an inability to intubate the client secondary to excessive edema formation in the neck.

Question 4 of 5

A client with a history of breast cancer is admitted with complaints of bone pain. The nurse should give priority to:

Correct Answer: B

Rationale: Bone pain in breast cancer may indicate bone metastasis, a common complication, so monitoring for metastasis is the priority.

Question 5 of 5

The nurse is performing discharge teaching on a client with polycythemia vera. Which would be included in the teaching plan?

Correct Answer: D

Rationale: Polycythemia vera increases blood viscosity, raising thrombosis risk. Teaching to recognize thrombosis symptoms (e.g., pain, swelling) is critical. Avoiding crowds (
A) is for neutropenia, elevating the bed (
B) is for reflux, and socks/gloves (
C) are for Raynaud’s.

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