NCLEX-RN
NCLEX RN Practice Questions Exam Cram
1. A victim of domestic violence states, 'If I were better, I would not have been beaten.' Which feeling best describes what the victim may be experiencing?
- A. Fear
- B. Helplessness
- C. Self-blame
- D. Rejection
Correct answer: C
Rationale: The correct answer is self-blame. In this scenario, the victim is attributing the abuse to their own inadequacies or faults, thinking that if they were different, the abuse would not occur. This is a common response seen in victims of domestic violence, where they wrongly internalize the blame for the abuser's actions. Fear (Choice A) is a valid emotion, but in this case, the victim is not expressing fear but rather self-blame. Helplessness (Choice B) is also a common feeling in victims of domestic violence, but in this specific statement, the victim is demonstrating self-blame. Rejection (Choice D) does not accurately reflect the victim's statement and emotional response in the given scenario.
2. Which oxygen delivery system would provide the highest concentrations of oxygen to the client?
- A. Venturi mask
- B. Partial rebreather mask
- C. Non-rebreather mask
- D. Simple face mask
Correct answer: C
Rationale: The correct answer is the non-rebreather mask. This oxygen delivery system has a one-way valve that prevents exhaled air from entering the reservoir bag and one or more valves covering the air holes on the face mask itself to prevent the inhalation of room air but allow exhalation of air. When a tight seal is achieved around the mask, up to 100% of oxygen is available. Choice A, the Venturi mask, delivers precise oxygen concentrations but not as high as the non-rebreather mask. Choice B, the partial rebreather mask, allows the client to rebreathe some exhaled air, resulting in lower oxygen concentrations than the non-rebreather mask. Choice D, the simple face mask, delivers low to moderate oxygen concentrations and is not designed to provide the highest concentrations like the non-rebreather mask.
3. Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis?
- A. Absent bowel sounds
- B. Abdominal tenderness
- C. Left upper quadrant pain
- D. Palpable abdominal mass
Correct answer: D
Rationale: The correct answer is a palpable abdominal mass. In a 46-year-old woman with acute pancreatitis, a palpable abdominal mass may indicate the presence of a pancreatic abscess, which requires rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common symptoms in acute pancreatitis but do not necessarily indicate an immediate need for surgical intervention. Therefore, the presence of a palpable abdominal mass is the most concerning finding in this scenario.
4. While planning care for a 2-year-old hospitalized child, which situation would the nurse expect to most likely affect the behavior?
- A. Strange bed and surroundings
- B. Separation from parents
- C. Presence of other toddlers
- D. Unfamiliar toys and games
Correct answer: B
Rationale: The correct answer is 'Separation from parents.' Separation anxiety is most evident from 6 months to 30 months of age and is the greatest stress imposed on a toddler by hospitalization. If separation is avoided, young children have a tremendous capacity to withstand other stress. The other choices, such as 'Strange bed and surroundings,' 'Presence of other toddlers,' and 'Unfamiliar toys and games,' may also have an impact on the child, but separation from parents is typically the most significant factor affecting behavior in a hospitalized 2-year-old.
5. 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.
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