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1. An adult's blood pressure reads 40/20. You place the patient in a Trendelenberg position before rechecking the blood pressure. What actions will you take to position the patient correctly?
- A. lower the head of the bed and raise the foot of the bed
- B. raise the head of the bed up to about 60 to 75 degrees
- C. raise the head of the bed up to about 75 to 90 degrees
- D. raise the siderails and place the bed in the high position
Correct answer: lower the head of the bed and raise the foot of the bed
Rationale: In a Trendelenberg position, used for low blood pressure, the correct action is to lower the head of the bed and raise the foot of the bed. This positioning facilitates the return of blood to the heart and helps increase blood pressure. Option B, raising the head of the bed to 60 to 75 degrees, is incorrect as it is not the Trendelenberg position. Option C, raising the head of the bed to 75 to 90 degrees, is incorrect as it does not align with the Trendelenberg position. Option D, raising the siderails and placing the bed in the high position, is incorrect as it does not address the specific positioning required for the Trendelenberg position.
2. Which of the following vital signs can be expected in a child that is afebrile?
- A. Rectal Temp of 100.9 degrees F.
- B. Oral Temp of 38 degrees C.
- C. Axillary Temp of 98.6 degrees F.
- D. All of the above are incorrect.
Correct answer: Axillary Temp of 98.6 degrees F.
Rationale: The correct answer is the axillary temperature of 98.6 degrees F. Afebrile means without a fever, and an axillary temperature, which is taken in the armpit, is considered normal at 98.6 degrees F. Choice A is incorrect as a rectal temperature of 100.9 degrees F indicates a fever. Choice B is incorrect as an oral temperature of 38 degrees C is also indicative of a fever. Choice D is incorrect as not all options are wrong; only choices A and B are incorrect for an afebrile child.
3. Which basic principle of Alcoholics Anonymous (AA) should a client with alcohol use disorder follow?
- A. Spouses should attend Al-Anon meetings.
- B. It is a commitment to focus on long-term goals.
- C. Amends must be made to each person who has been harmed.
- D. People have the power to overcome alcoholism if they truly want to stop drinking.
Correct answer: Amends must be made to each person who has been harmed.
Rationale: The correct answer is that amends must be made to each person who has been harmed. This principle is reflected in the eighth step of the 12 steps of AA, which involves making a list of all persons harmed and being willing to make amends to them. It is a fundamental principle of AA to address past harms and seek to rectify them. Choice A is incorrect because spouses attending Al-Anon meetings is not a basic principle of AA; it is a support group for family members of individuals with alcohol use disorder. Choice B is incorrect because while focusing on long-term goals can be beneficial, AA emphasizes taking one day at a time rather than committing to long-term goals. Choice D is incorrect because AA teaches that individuals struggling with alcoholism are powerless over their addiction and need to rely on a higher power rather than solely their willpower to overcome it.
4. Why should a palpated pressure be performed before auscultating blood pressure?
- A. To more clearly hear the Korotkoff sounds.
- B. To detect the presence of an auscultatory gap.
- C. To avoid missing a falsely elevated blood pressure.
- D. To more readily identify phase IV of the Korotkoff sounds.
Correct answer: To detect the presence of an auscultatory gap.
Rationale: Performing a palpated pressure before auscultating blood pressure helps in detecting the presence of an auscultatory gap. An auscultatory gap is a period during blood pressure measurement when Korotkoff sounds temporarily disappear before reappearing. Inflation of the cuff 20 to 30 mm Hg beyond the point where a palpated pulse disappears helps in identifying this gap. This technique ensures accurate blood pressure measurement by preventing the underestimation of blood pressure values. The other options are incorrect because palpating the pressure is not primarily done to hear Korotkoff sounds more clearly, avoid missing falsely elevated blood pressure, or readily identify a specific phase of Korotkoff sounds.
5. The healthcare provider is caring for a 20 lbs (9 kg) 6-month-old with a 3-day history of diarrhea, occasional vomiting, and fever. Peripheral intravenous therapy has been initiated, with 5% dextrose in 0.33% normal saline with 20 mEq of potassium per liter infusing at 35 ml/hr. Which finding should be reported to the healthcare provider immediately?
- A. 3 episodes of vomiting in 1 hour
- B. Periodic crying and irritability
- C. Vigorous sucking on a pacifier
- D. No measurable voiding in 4 hours
Correct answer: No measurable voiding in 4 hours
Rationale: The correct answer is 'No measurable voiding in 4 hours.' This finding should be reported to the healthcare provider immediately. The concern is the possibility of hyperkalemia, which could occur with continued potassium administration and a decrease in urinary output since potassium is excreted via the kidneys. It is crucial to monitor urinary output in pediatric patients receiving potassium-containing IV solutions to prevent electrolyte imbalances and potential complications. Choices A, B, and C are not the most critical findings that require immediate reporting. '3 episodes of vomiting in 1 hour' may suggest a need for antiemetic therapy or further assessment of the underlying cause but does not pose an immediate risk like the potential electrolyte imbalance from decreased urinary output. 'Periodic crying and irritability' and 'Vigorous sucking on a pacifier' are common behaviors in infants and are not indicative of a critical condition that requires urgent attention in this scenario.
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