NCLEX-RN
NCLEX RN Exam Prep
1. Nursing care plans contain which of the following?
- A. nursing diagnoses
- B. medical diagnoses.
- C. MD orders.
- D. intake and output forms
Correct answer: A
Rationale: Nursing care plans are legal documents that contain nursing diagnoses, such as an "Alteration of respiratory function". They also contain patient goals and nursing interventions.
2. During an initial assessment interview, which statement made by a patient should serve as the priority focus for the plan of care?
- A. "I can always trust my family."?
- B. "It seems like I always have bad luck."?
- C. "You never know who will turn against you."?
- D. "I hear evil voices that tell me to do bad things."?
Correct answer: D
Rationale: The statement about hearing evil voices indicates that the patient is experiencing auditory hallucinations, which is a significant symptom that requires immediate attention and intervention. This symptom can be associated with serious mental health conditions like psychosis. Choices A, B, and C are more general statements that do not provide specific information about the patient's mental health status or symptoms, making them less urgent and not as critical for the plan of care compared to the presence of auditory hallucinations.
3. What does an individual who believes in the magicoreligious theory of illness and disease think is the cause of illness?
- A. Germs and viruses
- B. Supernatural forces
- C. Eating imbalanced (hot/cold) foods
- D. Imbalance within his or her spiritual nature
Correct answer: B
Rationale: Individuals who adhere to the magicoreligious theory of illness and disease attribute the cause of illness to supernatural forces. In this perspective, the world is perceived as governed by supernatural forces that influence the well-being of individuals. The belief is that these forces can bring about both good and evil outcomes. Choices A, C, and D are incorrect. Germs and viruses are associated with the biomedical theory of illness. Eating imbalanced hot or cold foods is linked to the yin/yang naturalist theory. Imbalance within one's spiritual nature is not a recognized cause of illness in any of the established theories of illness.
4. The nurse is comparing the concepts of religion and spirituality. Which statement describes an appropriate component of one's spirituality?
- A. Belief in and worship of God or gods
- B. Being closely tied to one's ethnic background
- C. Attendance at a specific church or place of worship
- D. A connection with something larger than oneself and belief in transcendence
Correct answer: D
Rationale: Spirituality refers to a connection with something larger than oneself and a belief in transcendence. The other responses do not apply to spirituality. Choice A, 'Belief in and worship of God or gods,' and choice C, 'Attendance at a specific church or place of worship,' are more aligned with religious practices. Choice B, 'Being closely tied to one's ethnic background,' is not a defining aspect of spirituality or religion as it pertains more to cultural identity rather than spiritual beliefs.
5. A patient is bleeding profusely from an injury near her wrist. Which of the following first aid procedures would be MOST appropriate?
- A. Place a tourniquet on her arm above the injury.
- B. Place pressure on her brachial artery.
- C. Place pressure on her radial nerve.
- D. Cover the bleeding area with wet towels.
Correct answer: B
Rationale: The most appropriate first aid procedure for a patient bleeding profusely from an injury near the wrist is to place pressure on her brachial artery. Applying pressure to the brachial pulse point will help slow down the bleeding. Placing a tourniquet on her arm above the injury is not recommended as it could potentially inhibit blood flow, leading to tissue necrosis. Pressing on the radial nerve or covering the bleeding area with wet towels are not effective in controlling bleeding and may not address the underlying cause.
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