NCLEX-RN
NCLEX RN Exam Review Answers
1. A client with a new prescription for lithium carbonate for bipolar disorder is being educated by a nurse on early indications of toxicity. The nurse should include which of the following manifestations in the teachings?
- A. Constipation
- B. Polyuria
- C. Rash
- D. Tinnitus
Correct answer: B
Rationale: Polyuria is a crucial early indication of lithium toxicity. It results from the drug's effect on the kidneys, leading to increased urine output. This is a significant symptom to monitor as it can indicate potential toxicity. Constipation, rash, and tinnitus are not typically associated with early indications of lithium toxicity. Constipation is more commonly seen as a side effect of some medications, while rash and tinnitus are not specific indicators of lithium toxicity.
2. The nurse is providing disease prevention education to a 63-year-old woman with a negative family history of breast cancer. The nurse recommends the patient schedule mammograms with which frequency?
- A. Every 5 years
- B. Every 10 years
- C. Every other year
- D. Once a year
Correct answer: C
Rationale: Mammograms, along with breast self-examinations and other routine tests, are key for the early diagnosis and treatment of breast cancer. All major societies (WHO, ACS, USPSTF) recommend a screening mammogram every two years in women of this age at average risk of breast cancer. The recommended frequency may change if there are identified family history and significant risk factors. Choosing 'Once a year' is too frequent and not aligned with current guidelines. Opting for 'Every 5 years' or 'Every 10 years' intervals is not adequate for regular breast cancer screening and may increase the risk of cancer progression. Therefore, 'Every other year' is the most appropriate choice for this patient without a family history of breast cancer.
3. Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, Nurse Brienne would anticipate a problem with:
- A. Auditory hallucinations
- B. Bizarre behaviors
- C. Ideas of reference
- D. Motivation for activities
Correct answer: D
Rationale: In clients with negative symptoms of schizophrenia, such as Jaime, a common problem is avolition, which is the lack of motivation for activities. These 'negative' symptoms are characterized by inexpressive faces, blank looks, monotone speech, few gestures, and a seeming lack of interest in the world. Patients may also experience an inability to feel pleasure or act spontaneously. It is crucial to differentiate between the lack of expression and lack of feeling, as well as between lack of will and lack of activity. Auditory hallucinations (choice A) are positive symptoms, not typically associated with negative symptoms of schizophrenia. Bizarre behaviors (choice B) are more aligned with positive symptoms like disorganized behavior. Ideas of reference (choice C) involve incorrectly interpreting casual incidents and external events as having direct reference to oneself, which is not directly related to motivation for activities seen in negative symptoms.
4. What is the expected date of delivery for your pregnant client when her last menstrual period was on 10/20/2016
- A. 7/7/2017
- B. 8/7/2017
- C. 6/7/2017
- D. 8/1/2017
Correct answer: A
Rationale: The expected date of delivery is calculated using Nagle's rule which is: The first day of last menstrual period - 3 months + 7 days = the estimated date of delivery
5. A 27-year-old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and is hyperactive. Initially the nurse should plan this for a manic client:
- A. Set realistic limits to the client's behavior
- B. Repeat verbal instructions as often as needed
- C. Allow the client to express feelings to relieve tension
- D. Assign staff to be with the client at all times to help maintain control
Correct answer: A
Rationale: For a manic client who is hyperactive and may engage in injurious activities, setting realistic limits to the client's behavior is crucial to ensure safety. A quiet environment with firm and consistent limits helps in managing the client's behavior effectively. While repeating verbal instructions can be helpful due to the client's distractibility, it is not the priority compared to setting limits for safety concerns. Allowing the client to express feelings is important, but it should be done through non-destructive methods. Assigning staff to be with the client at all times is not realistic or feasible in the clinical setting and does not address the core issue of managing the client's behavior and ensuring safety.
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