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| Section | Weight | Objectives |
|---|
| Topic 1: Psychosocial Integrity | 6–12% | |
| Topic 2: Safe and Effective Care Environment | 17–33% | - Management of Care - Safety and Infection Control
|
| Topic 3: Health Promotion and Maintenance | 6–12% | |
| Topic 4: Physiological Integrity | 43–67% | - Physiological Adaptation - Pharmacological and Parenteral Therapies - Basic Care and Comfort - Reduction of Risk Potential
|
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NCLEX National Council Licensure Examination(NCLEX-RN) Sample Questions (Q655-Q660):
NEW QUESTION # 655
A 14-year-old teenager is hospitalized for anorexia nervosa. She is admitted to the adolescent mental health unit and placed on a behavior modification program. Nursing interventions for the teenager will most likely include:
- A. Requiring the client to eat more during meals
- B. Checking the client's room frequently
- C. Establishing routine tasks and activities around mealtimes
- D. Administering medications such as lithium
Answer: C
Explanation:
Explanation
(A) Providing a more structured, supportive environment addresses safety and comfort needs, thereby helping the anorexic client develop more internal control. (B) Medications (commonly antidepressants) are frequently ordered for the anorexic client. However, lithium (used primarily with bipolar disorder) is not commonly used to treat the anorexic client. (C) Requiring and/or demanding that the anorexic client "eat more" at mealtimes increases the client's feelings of powerlessness. (D) Like the previous strategy, checking the client's room frequently contributes to the client's feelings of powerlessness.
NEW QUESTION # 656
A 47-year-old client comes to the emergency department complaining of moderate flank, abdominal, and testicular pain with nausea of 4 hours' duration. After physical examination and obtaining the client's history, the physician suspects urethral obstruction by calculi. The nurse realizes that the physician will order which one of the following diagnostic studies to best confirm the diagnosis?
- A. Kidneys, ureter, bladder, x-ray of abdomen
- B. Cystoscopy
- C. Intravenous pyelogram with excretory urogram
- D. Ureterolithotomy
Answer: C
Explanation:
Explanation
(A) Cystoscopy is an endoscopic procedure that uses an instrument (a cystoscope) to visualize the internal bladder and ureter structures and to capture and remove an obstructing stone. (B) Kidney, ureter, bladder x-ray is used to outline gross structural changes in the kidneys, ureter, and bladder and will determine the general location of a stone. (C) An intravenous pyelogram with excretory urogram is used to visualize the kidneys, kidney pelvis, ureters, and bladder. This procedure is used specifically to determine whether urethral obstruction is partial or complete; it shows the exact location of the stone and dilation of the ureter above the stone. (D) Ureterolithotomy is a surgical procedure in which the ureter is incised and the stone is manually removed because the stone is unable to pass through the ureter independently.
NEW QUESTION # 657
A client had a hemicolectomy performed 2 days ago. Today, when the nurse assesses the incision, a small part of the abdominal viscera is seen protruding through the incision. This complication of wound healing is known as:
- A. Excoriation
- B. Evisceration
- C. Dehiscence
- D. Decortication
Answer: B
Explanation:
(A) Excoriation is abrasion of the epidermis or of the coating of any organ of the body by trauma, chemicals, burns, or other causes. (B) Dehiscence is a partial or complete separation of the wound edges with no protrusion of abdominal tissue. (C) Decortication is removal of the surface layer of an organ or structure. It is a type of surgery, such as removing the fibrinous peel from the visceral pleura in thoracic surgery. (D) Evisceration occurs when the incision separates and the contents of the cavity spill out.
NEW QUESTION # 658
A 15-year-old female adolescent is frequently breaking the rules of the unit. She has left the unit and was found smoking in the bathroom and spending a large amount of time in the male ward. Which statement by the nurse would best explain to the teenager why she must follow the rules of the unit?
- A. "Break the rules, all you want, but don't get caught again!"
- B. "You are not being fair to the other clients by getting them involved in your deviant behavior."
- C. "It is not easy, but the rules must be followed so that everyone can get a fair chance."
- D. "If you do not follow the rules, you will be transferred to the closed, locked unit."
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) This statement acknowledges that it is difficult but is not threatening or punitive. (B) This statement is threatening and describes specific punishment for further deviant behavior. (C) This response elicits shame by blaming her for involving others. (D) This response gives her permission to break the rules but indicates that getting caught is wrong.
NEW QUESTION # 659
At 12 hours postvaginal delivery, a female client is without complications. Which of the following assessment findings would warrant further nursing interventions?
- A. Apical pulse of 52 bpm
- B. No bowel movement since delivery
- C. Oral temperature of 100.4F
- D. Uterine fundus palpable left of midline
Answer: D
Explanation:
Explanation
(A) Bradycardia of 50-70 bpm may be considered normal postpartally because the heart compensates for the decreased resistance in the pelvis. (B) The uterus is displaced from the midline by a full bladder. This condition could lead to a boggy uterus and increased risk of postpartal hemorrhage; therefore, the bladder should be kept empty. (C) Re-establishment of normal bowel function is delayed into the first postpartum week. (D) A postpartum woman's oral temperature may go as high as 100.4_F within 24 hours of delivery resulting from muscular exertion, dehydration, and hormonal changes.
NEW QUESTION # 660
......
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