NCLEX-PN
NCLEX PN Exam Cram
1. What skin color does a client with jaundice have?
- A. pale
- B. ruddy
- C. yellow
- D. pink
Correct answer: C
Rationale: The correct answer is C: yellow. Jaundice is a condition characterized by yellowing of the skin due to increased levels of bilirubin in the blood. This excess bilirubin causes the skin and whites of the eyes to appear yellow. Choice A, pale, is not typically associated with jaundice. Choice B, ruddy, describes a reddish skin color and is not indicative of jaundice. Choice D, pink, is a normal skin color and not a symptom of jaundice.
2. A 20-year-old obese female client is preparing to have gastric bypass surgery for weight loss. She says to the nurse, "I need this surgery because nothing else I have done has helped me to lose weight."? Which response by the nurse is most appropriate?
- A. "If you eat less, you can save some money."?
- B. "Exercise is a healthier way to lose weight."?
- C. "You should try the Atkins diet first."?
- D. "I respect your decision to choose surgery."?
Correct answer: D
Rationale: The most appropriate response by the nurse is to show respect and empathy towards the client's decision. Option D acknowledges the client's autonomy and decision-making process, fostering a therapeutic relationship. Options A, B, and C are insensitive and unprofessional. Option A implies a financial incentive for weight loss, which can be perceived as disrespectful and trivializing the client's concerns. Option B suggests an alternative method without considering the client's reasons for choosing surgery, potentially invalidating her experiences. Option C recommends a specific diet without addressing the client's concerns or choices, neglecting her autonomy in decision-making.
3. What could be a possible cause for the symptoms experienced by the client in Question 28?
- A. iron deficiency
- B. folate deficiency
- C. peptic ulcer
- D. iron overload
Correct answer: A
Rationale: Given the client's symptoms of fatigue, shortness of breath, and lightheadedness, along with her gender and fad dieting, the most likely cause is iron deficiency. Iron deficiency commonly presents with these symptoms due to decreased oxygen-carrying capacity in the blood. Folate deficiency would typically present with different symptoms such as mouth sores and changes in skin, not fitting the client's presentation. Peptic ulcer would manifest with abdominal pain, not primarily with the symptoms described. Iron overload would present with symptoms such as joint pain and fatigue, which are not consistent with the client's presentation.
4. A healthcare professional is assessing a patient in the rehab unit during shift change. The patient has sustained a TBI 3 weeks ago. Which of the following is the most distinguishing characteristic of a neurological disturbance?
- A. LOC (level of consciousness)
- B. Short-term memory
- C. Babinski sign
- D. Clonus sign
Correct answer: A
Rationale: Level of consciousness (LOC) is the most crucial indicator of impaired neurological function. Changes in LOC can signify various neurological conditions, including traumatic brain injury. Short-term memory, while important, is not the most distinguishing characteristic of neurological disturbances. Babinski and Clonus signs are specific neurological tests that can provide information about upper motor neuron lesions but are not as generalizable as changes in LOC for assessing overall neurological status.
5. What is the most common cause of acute renal failure?
- A. Shock
- B. Nephrotoxic drugs
- C. Enlarged prostate
- D. Diabetes
Correct answer: A
Rationale: The most common cause of acute renal failure is shock. In cases of shock, such as hypovolemic shock where there is low blood volume, the kidneys receive inadequate blood flow leading to acute renal failure. This can result in the kidneys starting to die within 20 minutes of low pressure. While nephrotoxic drugs can also cause acute renal failure, shock is more commonly associated with this condition. An enlarged prostate can lead to urinary retention but is not the most common cause of acute renal failure. Diabetes, on the other hand, can cause chronic kidney disease over time but is not typically the primary cause of acute renal failure.
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