NCLEX-RN
NCLEX-RN Exam Questions
Question 1 of 5
The nurse is caring for a client with a history of glaucoma. The nurse should expect the client to have:
Correct Answer: A
Rationale: Glaucoma causes increased intraocular pressure, damaging the optic nerve and leading to peripheral vision loss, a hallmark symptom.
Question 2 of 5
A 2-year-old boy fell out of bed and has a subdural hematoma. When his mother leaves him for the first time, you will expect the child to:
Correct Answer: B
Rationale: This baby probably will cry, which should be prevented because it will increase his intracranial pressure (ICP). Asking the mother to wait until the baby is asleep may help.
Question 3 of 5
A male client seeks counseling after his wife of 19 years threatened to divorce him. For most of their marriage, he has physically and verbally abused her. When asked about his behavior in the process of the nursing assessment, the client states, 'I was mean to my wife because she insists on cooking meals and wearing clothes that I do not like.' This defense mechanism is an example of:
Correct Answer: D
Rationale: Repression is blocking a desire from conscious expression. The client is conscious of his desires. Regression is returning to an earlier form of expression, which is not demonstrated here. Reaction formation is acting out the opposite of true feelings. The client felt anger concerning his wife's cooking and acted out his feelings. Rationalization is unconsciously falsifying an experience by giving a 'rational' explanation. The client is attempting to justify his behavior by giving an explanation.
Question 4 of 5
The nurse is assessing a client with suspected appendicitis. Which clinical manifestation would the nurse expect to find?
Correct Answer: A
Rationale: Rebound tenderness in the right lower quadrant is a classic sign of appendicitis (e.g., Rovsing’s sign). Left upper quadrant pain (
B), distention (
C), and diarrhea (
D) are not typical.
Question 5 of 5
A normal 3-year-old child is suspected of having meningitis. The doctor has ordered a lumbar puncture. In light of this procedure and developmental characteristics of this age group, which nursing measure is most appropriate?
Correct Answer: A
Rationale: The nurse should emphasize what is required to elicit cooperation and help to develop a sense of autonomy. The child may express discomfort verbally and should be encouraged to express his feelings. Selecting nonthreatening words to explain a procedure will prevent misinterpretation. When explaining the procedure to the parent with the child present, the nurse should use words that the child can understand to avoid misunderstanding.