RN NCLEX ANSWERED QUESTIONS
100% COMPLETE SOLUTION GRADED
A+
A nurse is caring for an older adult patient who has a new diagnosis of type 2 diabetes
mellitus and reports difficulty following the diet and remembering to take the prescribed
medication.
Which of the following actions should the nurse take to promote patient compliance?
(SATA)
A. Ask the dietitian to assist with meal planning
B. Contact the patient's support system
C. Assess for age-related cognitive awareness
D. Encourage the use of a daily medication dispenser
E. Provide educational materials for home use - ANSWER A, B, D, E
A patient with diabetes mellitus has a glycosylated hemoglobin A1c level of 8%. On the
basis of this test result, the nurse plans to teach the patient about the need for which
measure?
A. Avoiding infection
B. Taking in adequate fluids
C. Preventing and recognizing hypoglycemia
D. Preventing and recognizing hyperglycemia - ANSWER D
Rationale:
The normal reference range for the glycosylated hemoglobin A1c is less than 6.0%.
This test measures the amount of glucose that has become permanently bound to the
red blood cells from circulating glucose. Erythrocytes live for about 120 days, giving
feedback about blood glucose for the past 120 days. Elevations in the blood glucose
level will cause elevations in the amount of glycosylation. Thus, the test is useful in
identifying patients who have periods of hyperglycemia that are undetected in other
ways. The estimated average glucose for a glycosylated hemoglobin A1c of 8% is 205
mg/dL (11.42 mmol/L). Elevations indicate continued need for teaching related to the
prevention of hyperglycemic episodes.
The nurse is instructing a patient how to perform a testicular self-examination (TSE).
The nurse should explain that which is the best time to perform this exam?
A. After a shower or bath
B. While standing to void
,C. After having a bowel movement
D. While lying in bed before arising - ANSWER A
Rationale:
The nurse needs to teach the patient how to perform a TSE. The nurse should instruct
the patient to perform the exam on the same day each month. The nurse should also
instruct the patient that the best time to perform a TSE is after a shower or bath when
the hands are warm and soapy and the scrotum is warm. Palpation is easier and the
patient will be better able to identify any abnormalities. The patient would stand to
perform the exam, but it would be difficult to perform the exam while voiding. Having a
bowel movement is unrelated to performing a TSE.
The clinic nurse prepares to perform a focused assessment on a patient who is
complaining of symptoms of a cold, a cough, and lung congestion. Which should the
nurse include for this type of assessment? Select all that apply.
A. Auscultating lung sounds
B. Obtaining the patient's temperature
C. Assessing the strength of peripheral pulses
D. Obtaining information about the patient's respirations
E. Performing a musculoskeletal and neurological examination
F. Asking the patient about a family history of any illness or disease - ANSWER A, B, D
Rationale:
A focused assessment focuses on a limited or short-term problem, such as the patient's
complaint. Because the patient is complaining of symptoms of a cold, a cough, and lung
congestion, the nurse would focus on the respiratory system and the presence of an
infection. A complete assessment includes a complete health history and physical
examination and forms a baseline database. Assessing the strength of peripheral
pulses relates to a vascular assessment, which is not related to this patient's
complaints. A musculoskeletal and neurological examination also is not related to this
patient's complaints. However, strength of peripheral pulses and a musculoskeletal and
neurological examination would be included in a complete assessment. Likewise,
asking the patient about a family history of any illness or disease would be included in a
complete assessment.
The clinic nurse is preparing to explain the concepts of Kohlberg's theory of moral
development with a parent. The nurse should tell the parent that which factor motivates
good and bad actions for the child at the preconventional level?
A. Peer pressure
B. Social pressure
C. Parents' behavior
D. Punishment and reward - ANSWER D
Rationale:
,In the preconventional stage, morals are thought to be motivated by punishment and
reward. If the child is obedient and is not punished, then the child is being moral. The
child sees actions as good or bad. If the child's actions are good, the child is praised. If
the child's actions are bad, the child is punished. Options 1, 2, and 3 are not associated
factors for this stage of moral development.
The maternity nurse is providing instructions to a new mother regarding the
psychosocial development of the newborn infant. Using Erikson's psychosocial
development theory, the nurse instructs the mother to take which measure?
A. Allow the newborn infant to signal a need.
B. Anticipate all needs of the newborn infant.
C. Attend to the newborn infant immediately when crying.
D. Avoid the newborn infant during the first 10 minutes of crying. - ANSWER A
Rationale:According to Erikson, the caregiver should not try to anticipate the newborn
infant's needs at all times but must allow the newborn infant to signal needs. If a
newborn infant is not allowed to signal a need, the newborn will not learn how to control
the environment. Erikson believed that a delayed or prolonged response to a newborn
infant's signal would inhibit the development of trust and lead to mistrust of others.
A nursing student is presenting a clinical conference to peers regarding Freud's
psychosexual stages of development, specifically the anal stage. The student explains
to the group that which characteristic relates to the anal stage?
A. This stage is associated with toilet training.
B. This stage is characterized by the gratification of self.
C. This stage is characterized by a tapering off of conscious biological and sexual
urges.
D. This stage is associated with pleasurable and conflicting feelings about the genital
organs. - ANSWER A
Rationale:
In general, toilet training occurs during the anal stage. According to Freud, the child
gains pleasure from the elimination of feces and from their retention. Option 2 relates to
the oral stage. Option 3 relates to the latency period. Option 4 relates to the phallic
stage.
The nurse is describing Piaget's cognitive developmental theory to pediatric nursing
staff. The nurse should tell that staff that which child behavior is characteristic of the
formal operations stage?
A. The child has the ability to think abstractly.
B. The child begins to understand the environment.
C. The child is able to classify, order, and sort facts.
D. The child learns to think in terms of past, present, and future. - ANSWER A
, Rationale:
In the formal operations stage, the child has the ability to think abstractly and logically.
Option 2 identifies the sensorimotor stage. Option 3 identifies the concrete operational
stage. Option 4 identifies the preoperational stage.
The mother of an 8-year-old child tells the clinic nurse that she is concerned about the
child because the child seems to be more attentive to friends than anything else. Using
Erikson's psychosocial development theory, the nurse should make which response?
A. "You need to be concerned."
B. "You need to monitor the child's behavior closely."
C. "At this age, the child is developing his own personality."
D. "You need to provide more praise to the child to stop this behavior." - ANSWER C
Rationale:According to Erikson, during school-age years (6 to 12 years of age), the child
begins to move toward peers and friends and away from the parents for support. The
child also begins to develop special interests that reflect his or her own developing
personality instead of the parents'. Therefore, options 1, 2, and 4 are incorrect
responses.
The nurse educator is preparing to conduct a teaching session for the nursing staff
regarding the theories of growth and development and plans to discuss Kohlberg's
theory of moral development. What information should the nurse include in the session?
Select all that apply
A. Individuals move through all 6 stages in a sequential fashion.
B. Moral development progresses in relationship to cognitive development.
C. A person's ability to make moral judgments develops over a period of time.
D. The theory provides a framework for understanding how individuals determine a
moral code to guide their behavior.
E. In stage 1 (punishment-obedience orientation), children are expected to reason as
mature members of society.
F. In stage 2 (instrumental-relativist orientation), the child conforms to rules to obtain
rewards or have favors returned. - ANSWER B, C, D, F
Rationale:
Kohlberg's theory states that individuals move through stages of development in a
sequential fashion but that not everyone reaches stages 5 and 6 in his or her
development of personal morality. The theory provides a framework for understanding
how individuals determine a moral code to guide their behavior. It states that moral
development progresses in relationship to cognitive development and that a person's
ability to make moral judgments develops over a period of time. In stage 1, ages 2 to 3
years (punishment-obedience orientation), children cannot reason as mature members
of society. In stage 2, ages 4 to 7 years (instrumental-relativist orientation), the child
conforms to rules to obtain rewards or have favors returned.
100% COMPLETE SOLUTION GRADED
A+
A nurse is caring for an older adult patient who has a new diagnosis of type 2 diabetes
mellitus and reports difficulty following the diet and remembering to take the prescribed
medication.
Which of the following actions should the nurse take to promote patient compliance?
(SATA)
A. Ask the dietitian to assist with meal planning
B. Contact the patient's support system
C. Assess for age-related cognitive awareness
D. Encourage the use of a daily medication dispenser
E. Provide educational materials for home use - ANSWER A, B, D, E
A patient with diabetes mellitus has a glycosylated hemoglobin A1c level of 8%. On the
basis of this test result, the nurse plans to teach the patient about the need for which
measure?
A. Avoiding infection
B. Taking in adequate fluids
C. Preventing and recognizing hypoglycemia
D. Preventing and recognizing hyperglycemia - ANSWER D
Rationale:
The normal reference range for the glycosylated hemoglobin A1c is less than 6.0%.
This test measures the amount of glucose that has become permanently bound to the
red blood cells from circulating glucose. Erythrocytes live for about 120 days, giving
feedback about blood glucose for the past 120 days. Elevations in the blood glucose
level will cause elevations in the amount of glycosylation. Thus, the test is useful in
identifying patients who have periods of hyperglycemia that are undetected in other
ways. The estimated average glucose for a glycosylated hemoglobin A1c of 8% is 205
mg/dL (11.42 mmol/L). Elevations indicate continued need for teaching related to the
prevention of hyperglycemic episodes.
The nurse is instructing a patient how to perform a testicular self-examination (TSE).
The nurse should explain that which is the best time to perform this exam?
A. After a shower or bath
B. While standing to void
,C. After having a bowel movement
D. While lying in bed before arising - ANSWER A
Rationale:
The nurse needs to teach the patient how to perform a TSE. The nurse should instruct
the patient to perform the exam on the same day each month. The nurse should also
instruct the patient that the best time to perform a TSE is after a shower or bath when
the hands are warm and soapy and the scrotum is warm. Palpation is easier and the
patient will be better able to identify any abnormalities. The patient would stand to
perform the exam, but it would be difficult to perform the exam while voiding. Having a
bowel movement is unrelated to performing a TSE.
The clinic nurse prepares to perform a focused assessment on a patient who is
complaining of symptoms of a cold, a cough, and lung congestion. Which should the
nurse include for this type of assessment? Select all that apply.
A. Auscultating lung sounds
B. Obtaining the patient's temperature
C. Assessing the strength of peripheral pulses
D. Obtaining information about the patient's respirations
E. Performing a musculoskeletal and neurological examination
F. Asking the patient about a family history of any illness or disease - ANSWER A, B, D
Rationale:
A focused assessment focuses on a limited or short-term problem, such as the patient's
complaint. Because the patient is complaining of symptoms of a cold, a cough, and lung
congestion, the nurse would focus on the respiratory system and the presence of an
infection. A complete assessment includes a complete health history and physical
examination and forms a baseline database. Assessing the strength of peripheral
pulses relates to a vascular assessment, which is not related to this patient's
complaints. A musculoskeletal and neurological examination also is not related to this
patient's complaints. However, strength of peripheral pulses and a musculoskeletal and
neurological examination would be included in a complete assessment. Likewise,
asking the patient about a family history of any illness or disease would be included in a
complete assessment.
The clinic nurse is preparing to explain the concepts of Kohlberg's theory of moral
development with a parent. The nurse should tell the parent that which factor motivates
good and bad actions for the child at the preconventional level?
A. Peer pressure
B. Social pressure
C. Parents' behavior
D. Punishment and reward - ANSWER D
Rationale:
,In the preconventional stage, morals are thought to be motivated by punishment and
reward. If the child is obedient and is not punished, then the child is being moral. The
child sees actions as good or bad. If the child's actions are good, the child is praised. If
the child's actions are bad, the child is punished. Options 1, 2, and 3 are not associated
factors for this stage of moral development.
The maternity nurse is providing instructions to a new mother regarding the
psychosocial development of the newborn infant. Using Erikson's psychosocial
development theory, the nurse instructs the mother to take which measure?
A. Allow the newborn infant to signal a need.
B. Anticipate all needs of the newborn infant.
C. Attend to the newborn infant immediately when crying.
D. Avoid the newborn infant during the first 10 minutes of crying. - ANSWER A
Rationale:According to Erikson, the caregiver should not try to anticipate the newborn
infant's needs at all times but must allow the newborn infant to signal needs. If a
newborn infant is not allowed to signal a need, the newborn will not learn how to control
the environment. Erikson believed that a delayed or prolonged response to a newborn
infant's signal would inhibit the development of trust and lead to mistrust of others.
A nursing student is presenting a clinical conference to peers regarding Freud's
psychosexual stages of development, specifically the anal stage. The student explains
to the group that which characteristic relates to the anal stage?
A. This stage is associated with toilet training.
B. This stage is characterized by the gratification of self.
C. This stage is characterized by a tapering off of conscious biological and sexual
urges.
D. This stage is associated with pleasurable and conflicting feelings about the genital
organs. - ANSWER A
Rationale:
In general, toilet training occurs during the anal stage. According to Freud, the child
gains pleasure from the elimination of feces and from their retention. Option 2 relates to
the oral stage. Option 3 relates to the latency period. Option 4 relates to the phallic
stage.
The nurse is describing Piaget's cognitive developmental theory to pediatric nursing
staff. The nurse should tell that staff that which child behavior is characteristic of the
formal operations stage?
A. The child has the ability to think abstractly.
B. The child begins to understand the environment.
C. The child is able to classify, order, and sort facts.
D. The child learns to think in terms of past, present, and future. - ANSWER A
, Rationale:
In the formal operations stage, the child has the ability to think abstractly and logically.
Option 2 identifies the sensorimotor stage. Option 3 identifies the concrete operational
stage. Option 4 identifies the preoperational stage.
The mother of an 8-year-old child tells the clinic nurse that she is concerned about the
child because the child seems to be more attentive to friends than anything else. Using
Erikson's psychosocial development theory, the nurse should make which response?
A. "You need to be concerned."
B. "You need to monitor the child's behavior closely."
C. "At this age, the child is developing his own personality."
D. "You need to provide more praise to the child to stop this behavior." - ANSWER C
Rationale:According to Erikson, during school-age years (6 to 12 years of age), the child
begins to move toward peers and friends and away from the parents for support. The
child also begins to develop special interests that reflect his or her own developing
personality instead of the parents'. Therefore, options 1, 2, and 4 are incorrect
responses.
The nurse educator is preparing to conduct a teaching session for the nursing staff
regarding the theories of growth and development and plans to discuss Kohlberg's
theory of moral development. What information should the nurse include in the session?
Select all that apply
A. Individuals move through all 6 stages in a sequential fashion.
B. Moral development progresses in relationship to cognitive development.
C. A person's ability to make moral judgments develops over a period of time.
D. The theory provides a framework for understanding how individuals determine a
moral code to guide their behavior.
E. In stage 1 (punishment-obedience orientation), children are expected to reason as
mature members of society.
F. In stage 2 (instrumental-relativist orientation), the child conforms to rules to obtain
rewards or have favors returned. - ANSWER B, C, D, F
Rationale:
Kohlberg's theory states that individuals move through stages of development in a
sequential fashion but that not everyone reaches stages 5 and 6 in his or her
development of personal morality. The theory provides a framework for understanding
how individuals determine a moral code to guide their behavior. It states that moral
development progresses in relationship to cognitive development and that a person's
ability to make moral judgments develops over a period of time. In stage 1, ages 2 to 3
years (punishment-obedience orientation), children cannot reason as mature members
of society. In stage 2, ages 4 to 7 years (instrumental-relativist orientation), the child
conforms to rules to obtain rewards or have favors returned.
