NCLEX-RN
Exam Cram NCLEX RN Practice Questions
1. When evaluating the temperature of older adults, what aspect should the healthcare provider remember about an older adult's body temperature?
- A. The body temperature of the older adult is lower than that of a younger adult.
- B. An older adult's body temperature is approximately the same as that of a young child.
- C. Body temperature varies based on the type of thermometer used.
- D. In older adults, body temperature can fluctuate widely due to less effective heat control mechanisms.
Correct answer: A
Rationale: When evaluating the temperature of older adults, it is important to note that their body temperature is usually lower than that of younger adults, with a mean temperature of 36.2�C. Choice B is incorrect because an older adult's body temperature is not approximately the same as that of a young child. Choice C is incorrect because body temperature is a physiological parameter and does not vary based on the type of thermometer used. Choice D is incorrect because while older adults may have less effective heat control mechanisms, their body temperature is typically lower, not widely fluctuating.
2. Which of the following is a fat-soluble vitamin?
- A. Vitamin C
- B. Vitamin D
- C. Vitamin B-6
- D. Riboflavin
Correct answer: B
Rationale: The correct answer is Vitamin D. Fat-soluble vitamins are those that can be stored in the body, allowing excess amounts to be stored for later use. While this storage ability can help prevent deficiencies, it also poses a risk of toxicity. The fat-soluble vitamins are A, E, D, and K. Choice A, Vitamin C, is water-soluble, not fat-soluble. Choice C, Vitamin B-6, and Choice D, Riboflavin, are also water-soluble vitamins and not fat-soluble.
3. Which of the following would be most important for the nurse to keep in mind regarding the use of side rails for a confused patient?
- A. A person of small stature is at increased risk for injury from entrapment.
- B. A history of a previous fall from a bed with raised side rails is significant.
- C. The desire to prevent a patient from wandering is not sufficient reason for the use of side rails.
- D. Creative use of alternative measures indicates respect for the patient's dignity.
Correct answer: A
Rationale: When considering the use of side rails for a confused patient, it is crucial for the nurse to understand that individuals of small stature are at a higher risk for injury from entrapment. Studies have shown that people of small stature are more likely to slip through or between the side rails, making them vulnerable to harm. It is essential to prioritize patient safety and avoid potential risks associated with entrapment. Conversely, a history of previous falls from a bed with raised side rails is significant as it indicates a heightened risk for future serious incidents. The desire to prevent a patient from wandering alone does not justify the use of side rails; instead, alternative measures should be creatively employed to respect the patient's dignity and avoid more serious fall-related injuries.
4. 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.
5. Which of these specific measurements is the best index of a child's general health?
- A. Body mass index
- B. Height and weight
- C. Head circumference
- D. Chest circumference
Correct answer: B
Rationale: Height and weight are the most accurate measurements to assess a child's general health. These measurements reflect the physical growth and development of the child, indicating overall health status. Choices C and D, head circumference and chest circumference, are important measurements for specific assessments but do not provide as comprehensive an overview of general health as height and weight. Body mass index (BMI) is a calculation based on height and weight, making height and weight more direct and primary indicators of a child's health compared to BMI.
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