NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
The nurse is performing a history on a client admitted for surgery in the morning. Which long-term medication in the client's history would be most important to report to the physician?
Correct Answer: A
Rationale: Prednisone, a corticosteroid, can affect wound healing, immune response, and adrenal function, requiring perioperative adjustments. Lisinopril (
B), Docusate (
C), and Oscal D (
D) are less likely to impact surgery acutely.
Question 2 of 5
A client is being discharged on warfarin (Coumadin), an oral anticoagulant. The nurse instructs him about using this drug. Which following response by the client indicates the need for further teaching?
Correct Answer: C
Rationale: Using an electric razor prevents the risk of cuts while shaving. Any physician or dentist should be informed of anticoagulant therapy because of the risk of bleeding due to a prolonged PT. The client should be instructed to consult with his physician. Aspirin is avoided because it potentiates the effects of oral anticoagulants by interfering with platelet aggregation. Identification bracelets are necessary to direct treatment, especially in an emergency situation.
Question 3 of 5
When assessing fetal heart rate status during labor, the monitor displays late decelerations with tachycardia and decreasing variability. What action should the nurse take?
Correct Answer: D
Rationale: This is not a normal occurrence. Late decelerations need prompt intervention for immediate infant recovery.
To increase O2 perfusion to the unborn infant, the mother should be placed on her left side. IV fluids should be increased, not decreased. Immediate action is warranted, such as reporting findings, turning mother on left side, administering O2, discontinuing oxytocin (Pitocin), assessing maternal blood pressure and the labor process, preparing for immediate cesarean delivery, and explaining plan of action to client.
Question 4 of 5
The nurse is caring for a client with a history of ectopic pregnancy. Which risk factor is most likely to be present?
Correct Answer: A
Rationale: Pelvic inflammatory disease (PI
D) is a major risk factor for ectopic pregnancy as it can scar the fallopian tubes impairing embryo transport. Gestational diabetes hypertension and multiple gestations are not strongly associated.
Question 5 of 5
A 14-year-old teenager is demonstrating behavior indicative of an obsessive-compulsive disorder. She is obsessed with her appearance. She will not leave her room until her hair, clothes, and makeup are perfect. She always dresses immaculately. Recently, she expressed disgust over her appearance after she gained 5 lb. After observing a marked weight loss over a 2-week period, her mother suspects that she is experiencing bulimia. She eats everything on her plate, then runs to the bathroom. In interviewing the teenager, she discusses in great detail all of the events leading to her bulimia, but not her feelings. What defense mechanism is she using?
Correct Answer: B
Rationale: Dissociation is separating a group of mental processes from consciousness or identity, such as multiple personalities. That is not evident in this situation. Intellectualization is excessive use of reasoning, logic, or words usually without experiencing associated feelings. This is the defense mechanism that this client is using. Rationalization is giving a socially acceptable reason for behavior rather than the actual reason. She is discussing events, not reasons. Displacement is a shift of emotion associated with an anxiety-producing person, object, or situation to a less threatening object.