NCLEX-RN
NCLEX RN Simulated Exam Test Bank Questions
Extract:
Question 1 of 5
Which of the following organs would be described as being located retroperitoneally?
Correct Answer: A
Rationale: The term 'retroperitoneal' refers to organs positioned behind the peritoneum. The kidneys are retroperitoneal organs, located outside the peritoneal cavity, against the posterior abdominal wall. This positioning provides them with additional protection from external forces due to the surrounding structures. The thymus, small intestines, and spleen are not retroperitoneal organs. The thymus is located in the mediastinum, the small intestines are intraperitoneal, and the spleen is intraperitoneal and located in the left upper quadrant of the abdomen.
Question 2 of 5
A registered nurse who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN?
Correct Answer: C
Rationale: When assigning a floated nurse from another unit to a client in the emergency department, the goal is to choose a patient with minimal anticipated immediate complications. In this scenario, the adolescent with terminal cancer who has been on pain medications and presents with pinpoint pupils and a relaxed respiratory rate of 11 is the most stable option. These assessment findings indicate opioid toxicity, which, while serious, has the least risk of immediate complications compared to the other clients.
Choice A involves a middle-aged client experiencing symptoms of possible cardiac issues due to diet pill overdose, which requires urgent intervention.
Choice B presents a young adult with concerning symptoms of potential psychosis or substance withdrawal, requiring immediate attention.
Choice D involves an elderly client who recently used crack, posing a high-risk situation that requires prompt evaluation and intervention.
Therefore, the correct choice is the adolescent with opioid toxicity, as this client has the least immediate risk of complications among the options provided.
Question 3 of 5
How does the procedure for taking a pulse rate on an infant differ from an adult?
Correct Answer: B
Rationale: The correct answer is B: The apical pulse method is used on infants. This method involves placing a stethoscope in the fifth intercostal space, mid-clavicular line, and counting the beats for a full minute. It is a preferred method for infants due to their small size and the difficulty in palpating peripheral pulses accurately.
Choices A, C, and D are incorrect.
Choice A is incorrect as pulse rates are indeed taken on infants, albeit using a different method.
Choice C is incorrect as a sphygmomanometer is typically used for measuring blood pressure, not pulse rates.
Choice D is incorrect as pulse rates on infants are usually taken apically in the fifth intercostal space, not the third.
Question 4 of 5
Which of the following is an anthropometric measurement?
Correct Answer: D
Rationale: Anthropometric measurements relate to the size, weight, and proportions of the human body. Weight is a key anthropometric measurement as it directly reflects body mass, making it the correct choice. Blood pressure, temperature, and pulse rate are physiological measurements that do not specifically pertain to body size or proportion, hence making them incorrect choices in the context of anthropometric measurements.
Question 5 of 5
A patient is asked to abduct her arms. Which of the following accurately describes her arm movement?
Correct Answer: A
Rationale: Abduction refers to moving a body part away from the midline of the body. In this case, when the patient abducts her arms, she is moving them away from her trunk.
Choice A is correct.
Choices B, C, and D are incorrect.
Choice B describes adduction, which is the movement of a body part toward the midline.
Choice C describes wrist rotation, not arm abduction.
Choice D describes crossing the arms over the abdomen, which is not the movement associated with abduction.