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

Questions 158

NCLEX-RN

NCLEX-RN Test Bank

NCLEX RN Nursing Exam Questions

Extract:


Question 1 of 5

The nurse should facilitate bonding during the postpartum period. What should the nurse expect to observe in the taking-hold phase?

Correct Answer: B

Rationale: In the taking-hold phase, the mother actively engages with the infant, such as calling the infant by name, indicating bonding.

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

The parents of a 9-year-old child with acute lymphocytic leukemia expressed concern about his alopecia from cranial irradiation. The nurse explains that:

Correct Answer: D

Rationale: Alopecia has occurred, and knowing it is a side effect does not address their concern. Although true, it does not give them hope for the future. Although true, it does not provide them with information of the temporary nature of the situation. Knowing the hair will grow back provides comfort that the alopecia is temporary.

Question 4 of 5

The physician has ordered 50 mEq of potassium chloride for a client with a potassium level of 2.5 mEq/L. The nurse should administer the medication:

Correct Answer: C

Rationale: Potassium chloride for hypokalemia (2.5 mEq/L) should be administered via controlled IV infusion over several hours (e.g., five hours) to prevent rapid shifts that could cause arrhythmias.

Question 5 of 5

The nurse is caring for a client with a history of Raynaud’s disease. The nurse should expect the client to have:

Correct Answer: A

Rationale: Raynaud’s disease causes vasospasms, leading to color changes (white, blue, red) in the fingers triggered by cold or stress.

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