NCLEX-RN
NCLEX RN Practice Questions Exam Cram
1. Which interventions should the nurse include when creating a care plan for a child with hepatitis? Select one that doesn't apply.
- A. Providing a low-fat, well-balanced diet.
- B. Teaching the child effective hand-washing techniques.
- C. Notifying the primary health care provider (PHCP) if jaundice is present.
- D. Instructing the parents to avoid administering medications unless prescribed.
Correct answer: D
Rationale: The correct answer is instructing the parents to avoid administering medications unless prescribed. This choice is not directly related to the care of a child with hepatitis. It is essential for the nurse to educate the child and family about providing a low-fat, well-balanced diet to support the liver, teaching effective hand-washing techniques to prevent the spread of infection, and notifying the primary health care provider if jaundice is present to monitor the progression of the disease and adjust the treatment plan accordingly. Avoiding unnecessary medications is crucial, but it should be done under healthcare provider guidance, so the statement should be revised to reflect this aspect. Therefore, the other options are appropriate for the care of a child with hepatitis.
2. The nurse is discussing negativism with the parents of a 30-month-old child. How should the nurse advise the parents to best respond to this behavior?
- A. Reprimand the child and give a 15-minute 'time out'
- B. Maintain a permissive attitude for this behavior
- C. Use patience and a sense of humor to deal with this behavior
- D. Assert authority over the child through limit setting
Correct answer: C
Rationale: Use patience and a sense of humor to deal with this behavior. The nurse should help the parents understand that negativism is a normal part of a toddler's growth towards autonomy. Reacting with patience and humor can help diffuse the situation and maintain a positive relationship with the child. Reprimanding the child and giving a 'time out' (Choice A) may not be effective for addressing negativism and can lead to power struggles. Maintaining a permissive attitude (Choice B) may reinforce negative behavior. Asserting authority through limit setting (Choice D) may be necessary in some situations, but using patience and humor is a more effective initial approach for handling negativism.
3. What is the primary nursing concern when caring for patients being treated with splints, casts, or traction?
- A. To assess for and prevent neurovascular complications or dysfunction
- B. To ensure adequate nutrition during the healing process
- C. To provide patient education for maintenance of splints, casts, or traction in the community
- D. To treat acute pain
Correct answer: A
Rationale: The primary nursing concern when caring for patients with splints, casts, or traction is to assess for and prevent neurovascular complications or dysfunction. This is crucial to ensure adequate circulation and nerve function, preventing long-term complications such as ischemia or nerve damage. While adequate nutrition and patient education are important aspects of care, they are not the primary concern in this scenario. Acute pain management is important but is secondary to preventing neurovascular complications in patients treated with splints, casts, or traction.
4. While eating in the hospital cafeteria, a nurse notices a toddler at a nearby table choking on a piece of food and appearing slightly blue. What is the appropriate initial action to take?
- A. Begin mouth-to-mouth resuscitation
- B. Give the child water to help with swallowing
- C. Perform 5 abdominal thrusts
- D. Call for the emergency response team
Correct answer: C
Rationale: When a toddler is choking on a piece of food and appears blue, it indicates airway obstruction. The appropriate initial action should be to perform 5 abdominal thrusts. This technique can help dislodge the obstructing object and clear the airway. Initiating mouth-to-mouth resuscitation is not recommended as the first step in a choking emergency, especially in children. Giving water may not be effective and can worsen the situation by causing further blockage. Calling the emergency response team should be considered if the abdominal thrusts are unsuccessful in clearing the airway.
5. A client has developed a vitamin C deficiency. Which of the following symptoms might the nurse most likely see with this condition?
- A. Cracks at the corners of the mouth
- B. Altered mental status
- C. Bleeding gums and loose teeth
- D. Anorexia and diarrhea
Correct answer: C
Rationale: A client with a severe vitamin C deficiency has a condition called scurvy. Scurvy is characterized by symptoms such as bleeding gums, loose teeth, poor wound healing, and easy bruising. The correct answer is 'Bleeding gums and loose teeth' because these are classic signs of scurvy due to vitamin C deficiency. Choice A ('Cracks at the corners of the mouth') is more indicative of a deficiency in B vitamins, specifically riboflavin. Choice B ('Altered mental status') is not typically associated with vitamin C deficiency but can occur with other conditions like vitamin B12 deficiency. Choice D ('Anorexia and diarrhea') are not common symptoms of vitamin C deficiency, as they are more commonly associated with other gastrointestinal issues or deficiencies in different nutrients.
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