NCLEX-RN
NCLEX RN Exam Prep
1. Which of the following is an example of emotional abuse?
- A. A slap to the person's hand
- B. Threatening the person
- C. Ignoring and isolating a person
- D. Leaving a patient soiled for hours
Correct answer: C
Rationale: Emotional abuse involves behaviors that harm an individual's self-worth and emotional well-being. Threatening someone instills fear and causes psychological distress, making it a clear example of emotional abuse. Choices A, C, and D involve physical abuse, neglect, and neglect of care, respectively, rather than emotional abuse. A slap to the person's hand constitutes physical abuse, ignoring and isolating a person is neglectful behavior, and leaving a patient soiled for hours falls under neglect of care.
2. An adult patient is at the clinic for a physical examination. The patient states that they are feeling 'very anxious' about the physical examination. What steps can the nurse take to make the patient more comfortable?
- A. Appear unhurried and confident when examining the patient.
- B. Leave the room when the patient undresses unless they need assistance.
- C. Ask the patient to change into an examining gown and to leave their undergarments on.
- D. Measure vital signs at the beginning of the examination to gradually accustom the patient.
Correct answer: A
Rationale: To help alleviate the patient's anxiety, the nurse should appear unhurried and confident during the examination. This can make the patient feel more at ease and reassured. It is important for the nurse to respect the patient's privacy by leaving the room while the patient changes unless assistance is needed. The patient should be instructed to change into an examining gown while leaving their undergarments on, providing a sense of comfort and familiarity. Additionally, measuring vital signs at the beginning of the examination can help gradually acclimate the patient to the process, making it less overwhelming. Therefore, the correct answer is to appear unhurried and confident when examining the patient. Choices B, C, and D are incorrect because they do not directly address the patient's anxiety or provide comfort in the same way as the correct answer.
3. A client is complaining of pain that starts in the shoulder and travels down the length of his arm. This type of pain is referred to as:
- A. Referred pain
- B. Superficial pain
- C. Radiating pain
- D. Precipitating pain
Correct answer: C
Rationale: Radiating pain is the correct term for pain that originates in one part of the body and extends to other related areas. In this scenario, the pain starting in the shoulder and traveling down the arm describes radiating pain. Referred pain (Choice A) is pain felt at a site different from the actual origin of the pain. Superficial pain (Choice B) is pain that arises from the skin or tissues just beneath it. Precipitating pain (Choice D) refers to pain that is triggered by specific actions or events, not the characteristic described in the question.
4. Should standard precautions be used when providing post mortem care to a patient who has died from a massive heart attack and had no other diseases, illnesses, or infections?
- A. Yes, because the patient must be treated with respect
- B. Yes, you still must use standard precautions
- C. No, because the patient had no infections
- D. No, because this is not respectful
Correct answer: B
Rationale: Yes, you must still use standard precautions when providing post mortem care, regardless of the patient's medical history. Standard precautions are essential to prevent the transmission of potential infectious agents and protect both the healthcare provider and others from exposure. Even if the patient did not have known infections, it is crucial to maintain a safe environment and uphold professional standards of care. Choice A is incorrect as using standard precautions is primarily for infection control rather than solely for respect. Choices C and D are incorrect as the absence of infections or the notion of respect does not negate the need for standard precautions in post mortem care.
5. When assessing a patient's pulse, which of the following characteristics would the nurse also notice?
- A. Force
- B. Pallor
- C. Capillary refill time
- D. Timing in the cardiac cycle
Correct answer: A
Rationale: When assessing a patient's pulse, the nurse should observe characteristics such as rate, rhythm, and force. Force refers to the strength or amplitude of the pulse, which provides important information about cardiac output. Pallor is the paleness of the skin and is not directly related to pulse assessment. Capillary refill time is used to assess peripheral perfusion and is not specifically part of pulse assessment. Timing in the cardiac cycle is a broader concept and not a characteristic directly assessed during a pulse examination. Therefore, choice A, 'Force,' is the correct answer as it aligns with the standard parameters evaluated during pulse assessment.
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