NCLEX-RN
NCLEX RN Exam Preview Answers
1. The healthcare professional is preparing to percuss the abdomen of a patient. What characteristic of the underlying tissue does percussion assess?
- A. Turgor
- B. Texture
- C. Density
- D. Consistency
Correct answer: C
Rationale: Percussion is a technique used to assess the density of underlying organs by producing sounds that help determine their location and size. Turgor, texture, and consistency are primarily assessed through palpation, not percussion. Turgor refers to skin elasticity, texture pertains to the feel of the tissue surface, and consistency relates to the firmness or resistance of the tissue.
2. How many cc are there in 25 ounces?
- A. 250
- B. 500
- C. 750
- D. 1000
Correct answer: C
Rationale: To convert ounces to cc, we know that there are 30 cc in 1 ounce. Therefore, to find out how many cc are in 25 ounces, we multiply 30 cc/ounce by 25 ounces which equals 750 cc. This makes choice C, 750, the correct answer. Choices A, B, and D are incorrect as they do not correctly convert ounces to cc.
3. When measuring a patient's body temperature, what factor should be considered that can influence the temperature?
- A. Constipation
- B. Diurnal cycle
- C. Nocturnal cycle
- D. Patient's emotional state
Correct answer: B
Rationale: When measuring body temperature, it is essential to consider factors that can influence it. The diurnal cycle, which refers to the body's natural temperature variations throughout a 24-hour period, can impact body temperature readings. Factors like exercise, age, and environment can also affect body temperature. Constipation does not directly influence body temperature. The 'nocturnal cycle' is not a recognized term in relation to body temperature. While a patient's emotional state can affect vital signs, it is not a primary factor in influencing body temperature measurements.
4. During an assessment, a nurse asks a patient, "If you had fever and vomiting for 3 days, what would you do?"? Which aspect of the mental status examination is the nurse assessing?
- A. Behavior
- B. Cognition
- C. Affect and mood
- D. Perceptual disturbances
Correct answer: B
Rationale: The nurse is assessing cognition in this scenario. Cognition involves evaluating a patient's judgment and decision-making abilities. By asking the patient what they would do in a specific situation, the nurse aims to determine the patient's cognitive function. A correct response indicating intact cognition would involve a decision like 'Call my doctor.' If the patient suggests inappropriate actions like 'I would stop eating' or 'I would just wait and see what happened,' it would suggest impaired judgment. The other options, behavior, affect and mood, and perceptual disturbances, refer to different aspects of the mental status examination and are not directly assessed through this question.
5. What does preload refer to?
- A. The volume of blood entering the left side of the heart
- B. The volume of blood entering the right side of the heart
- C. The pressure in the venous system that the heart must overcome to pump the blood
- D. The pressure in the arterial system that the heart must overcome to pump the blood
Correct answer: B
Rationale: Preload refers to the volume of blood that enters the right side of the heart. This volume stretches the fibers in the heart before contraction. Preload is an essential factor in determining the force of ventricular contraction. Choices A, C, and D are incorrect. Choice A is incorrect because preload is specifically related to the volume of blood entering the right side of the heart. Choices C and D are incorrect as they refer to afterload, which is the pressure that the heart must overcome to pump blood out of the ventricles into the systemic or pulmonary circulation.
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