NCLEX-RN
NCLEX RN Actual Exam Test Bank
1. Which of the following is an example of client handling equipment?
- A. Wheelchair
- B. Height-adjustable bed
- C. Shower chair
- D. Call light
Correct answer: B
Rationale: Client handling equipment is designed to reduce stress and workload on healthcare professionals who assist, turn, or lift clients, aiming to decrease the risk of injuries from improper lifting techniques. A height-adjustable bed is a prime example of client handling equipment as it allows healthcare providers to raise the client to a suitable working height, facilitating care provision. Choices A, C, and D are not examples of client handling equipment. While a wheelchair, shower chair, and call light are essential in client care settings, they are not intended to aid in handling and lifting clients.
2. Which of the following organs would be described as being located retroperitoneally?
- A. Kidneys
- B. Thymus
- C. Small Intestines
- D. Spleen
Correct answer: A
Rationale: The term 'retroperitoneal' refers to organs positioned behind the peritoneum. The kidneys are retroperitoneal organs, located outside the peritoneal cavity, against the posterior abdominal wall. This positioning provides them with additional protection from external forces due to the surrounding structures. The thymus, small intestines, and spleen are not retroperitoneal organs. The thymus is located in the mediastinum, the small intestines are intraperitoneal, and the spleen is intraperitoneal and located in the left upper quadrant of the abdomen.
3. A client with expressive aphasia is pointing wildly at the bath water but unable to speak. Which response from the nurse is most appropriate?
- A. Is something wrong with the bath water?
- B. Just calm down, we'll finish your bath soon.
- C. Are you trying to tell me something?
- D. Shall I turn on the television?
Correct answer: A
Rationale: A client with expressive aphasia faces difficulty expressing themselves verbally but can understand others. In this scenario, the client's gestures indicate a communication attempt. The nurse's best response is to directly address the potential issue the client is indicating, which is the bath water. Option A acknowledges the client's non-verbal communication and seeks to address their concern. Choices B, C, and D do not directly address the client's attempt to communicate about the bath water, which is the focal point of the interaction.
4. After change-of-shift report, which patient should the nurse assess first?
- A. 72-year-old with cor pulmonale who has 4+ bilateral edema in his legs and feet
- B. 28-year-old with a history of a lung transplant and a temperature of 101 F (38.3 C)
- C. 40-year-old with a pleural effusion who is complaining of severe stabbing chest pain
- D. 64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion
Correct answer: D
Rationale: The patient with lung cancer and tracheal deviation after a subclavian catheter insertion should be assessed first. Tracheal deviation can indicate tension pneumothorax, a life-threatening condition that requires immediate intervention to prevent inadequate cardiac output or hypoxemia. While the other patients also need assessment, the potential for tension pneumothorax in the patient with tracheal deviation necessitates urgent attention to prevent complications.
5. Many Asians believe in the yin/yang theory, which is rooted in the ancient Chinese philosophy of Tao. Which statement most accurately reflects this philosophy's view of "health"??
- A. A person is able to work and produce.
- B. A person is happy, stable, and feels good.
- C. All aspects of the person are in perfect balance.
- D. A person is able to care for others and function socially.
Correct answer: C
Rationale: In the yin/yang theory rooted in ancient Chinese philosophy, health is believed to exist when all aspects of a person are in perfect balance. This includes physical, mental, emotional, and spiritual well-being. Choice C accurately reflects this philosophy's view of health. Choices A, B, and D do not capture the essence of the yin/yang theory. Being able to work and produce, being happy and stable, or caring for others and functioning socially, while important, do not encompass the holistic balance emphasized in the yin/yang theory.
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