NCLEX-RN
Exam Cram NCLEX RN Practice Questions
1. A child presents to the emergency department with colicky abdominal pain in the lower right quadrant. What disorder is suspected based on these symptoms?
- A. Peritonitis
- B. Appendicitis
- C. Intussusception
- D. Hirschsprung's disease
Correct answer: B
Rationale: The child's presentation of colicky abdominal pain in the lower right quadrant is classic for appendicitis. Appendicitis typically presents with localized pain that starts near the umbilicus and then shifts to the right lower quadrant. Peritonitis, on the other hand, is characterized by diffuse abdominal pain, tenderness, and guarding, usually resulting from organ perforation or intestinal obstruction. Intussusception is associated with acute, severe abdominal pain and currant jelly-like stools due to intestinal telescoping. Hirschsprung's disease, which lacks ganglion cells in the colon, manifests with symptoms like constipation, abdominal distension, and foul-smelling, ribbon-like stools.
2. A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful?
- A. The absence of special cells in the rectum caused the disease.
- B. Incomplete digestion of the protein part of wheat, barley, rye, and oats is not the cause of the disease.
- C. The disease does not occur due to increased bowel motility leading to spasm and pain.
- D. The disease is not caused by the inability to tolerate sugar found in dairy products.
Correct answer: A
Rationale: Hirschsprung's disease, also known as congenital aganglionosis or megacolon, is characterized by the absence of ganglion cells in the rectum and, sometimes, extending into the colon. Choice A correctly explains the cause of Hirschsprung's disease. Choice B is incorrect as it describes celiac disease, which is related to gluten intolerance. Choice C is inaccurate as it describes symptoms of irritable bowel syndrome, not the cause of Hirschsprung's disease. Choice D is wrong as it pertains to lactose intolerance, not Hirschsprung's disease.
3. The patient in the emergency room has a history of alprazolam (Xanax) abuse and abruptly stopped taking Xanax about 24 hours ago. He presents with visible tremors, pacing, fear, impaired concentration, and memory. Which intervention takes priority?
- A. Have the patient lie down on a stretcher with bed rails raised
- B. Offer the patient a cup of water and a small amount of food
- C. Reassure the patient about his well-being
- D. Inform the physician about the patient's Xanax withdrawal
Correct answer: A
Rationale: The 1-4 day period after Xanax withdrawal is critical as it poses the highest risk of life-threatening seizures. Alprazolam is a benzodiazepine, and sudden cessation can lead to severe withdrawal symptoms. The patient's visible tremors, fear, pacing, and cognitive impairment indicate a state of heightened distress and potential seizure risk. Placing the patient on a stretcher with raised bed rails is essential for seizure precautions, ensuring safety and preventing injury during a potential seizure. Offering water and food, reassuring the patient, or informing the physician about Xanax withdrawal are not immediate priorities compared to managing the risk of seizures in this high-risk situation.
4. In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school-age child for evaluation?
- A. Polyphagia
- B. Dehydration
- C. Bedwetting
- D. Weight loss
Correct answer: C
Rationale: The correct answer is 'Bedwetting.' One of the initial symptoms of type 1 diabetes in children is bedwetting. Parents are likely to notice bedwetting in a school-age child, prompting them to seek evaluation. Polyphagia (excessive hunger) and weight loss are also common symptoms of diabetes but may not be as readily noticeable to parents compared to bedwetting. Dehydration is a consequence of diabetes rather than an early symptom that would prompt parents for evaluation.
5. The clinic nurse is obtaining data about a child with a diagnosis of lactose intolerance. Which data should the nurse expect to obtain on assessment?
- A. Reports of frothy stools and diarrhea
- B. Reports of foul-smelling ribbon stools
- C. Reports of profuse, watery diarrhea and vomiting
- D. Reports of diffuse abdominal pain unrelated to meals or activity
Correct answer: A
Rationale: Lactose intolerance commonly presents with frothy stools and diarrhea due to the inability to digest lactose. Other symptoms include abdominal distension, crampy abdominal pain, and excessive flatus. Foul-smelling ribbon stools are indicative of Hirschsprung's disease, not lactose intolerance. Profuse, watery diarrhea and vomiting are more characteristic of celiac disease. Diffuse abdominal pain unrelated to meals or activity is a typical symptom of irritable bowel syndrome, not lactose intolerance.
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