NCLEX RN EXAM QUESTIONS AND ANSWERS LATEST UPDATE
2023/2024 WITH CORRECT VERIFIED AND EXPLAINED
ANSWERS TOP RANKED A+ FOR SUCCESS
Exam : NCLEX-RN
Title : National Council Licensure
Examination(NCLEX-RN)
Vendor : NCLEX
Version : V12.35
1
,NCLEX RN EXAM QUESTIONS AND ANSWERS LATEST UPDATE
2023/2024 WITH CORRECT VERIFIED AND EXPLAINED
ANSWERS TOP RANKED A+ FOR SUCCESS
NO.1
The primary focus of nursing interventions for the child experiencing sickle cell crisis is
aimed toward:
A. Maintaining an adequate level of hydration
B. Providing pain relief
C. Preventing infection
D. O2 therapy Answer: A Explanation:
(A) Maintaining the hydration level is the focus for nursing intervention because
dehydration enhances the sickling process. Both oral and parenteral fluids are used. (B)
The pain is a result of the sickling process. Analgesics or narcotics will be used for
symptom relief, but the underlying cause of the pain will be resolved with hydration.
(C) Serious bacterial infections may result owing to splenic dysfunction. This is true at
all times, not just during the acute period of a crisis. (D) O2 therapy is used for
symptomatic relief of the hypoxia resulting from the sickling process. Hydration is the
NO.2
A 29-year-old client delivered her fifth child by the Lamaze method and developed a
postpartal hemorrhage in the recovery room. What are the initial symptoms of shock
that she may experience?
A. Marked elevation in blood pressure, respirations, and pulse
B. Decreased systolic pressure, cold skin, and anuria
C. Rapid pulse; narrowed pulse pressure; cool, moist skin
D. No urinary output, tachycardia, and restlessness
Answer: C Explanation:
(A) Early shock does not exhibit the symptom of marked elevation in blood pressure. A
narrowing of the pulse pressure is indicative of early shock. (B) Anuria is a clinical finding
in late shock. (C) All of these clinical findings are congruent with early shock. (D) Absence
2
,NCLEX RN EXAM QUESTIONS AND ANSWERS LATEST UPDATE
2023/2024 WITH CORRECT VERIFIED AND EXPLAINED
ANSWERS TOP RANKED A+ FOR SUCCESS
of urinary output is a clinical finding in the late phase of shock.
NO.3 A 24-year-old client presents to the emergency department protesting "I am God."
The nurse identifies this as a:
A. Delusion
B. Illusion
C. Hallucination
D. Conversi
on Answer:
A
Explanation
:
(A) Delusion is a false belief. (B) Illusion is the misrepresentation of a real, external
sensory experience. (C) Hallucination is a false sensory perception involving any of the
senses. (D) Conversion is the expression of intrapsychic conflict through sensory or
motor manifestations.
NO.4 In acute episodes of mania, lithium is effective in 1-2 weeks, but it may take up to
4 weeks, or
3
, NCLEX RN EXAM QUESTIONS AND ANSWERS LATEST UPDATE
2023/2024 WITH CORRECT VERIFIED AND EXPLAINED
ANSWERS TOP RANKED A+ FOR SUCCESS
even a few months, to treat symptoms fully. Sometimes an antipsychotic agent is
prescribed during the first few days or weeks of an acute episode to manage severe
behavioral excitement and acute psychotic symptoms. In addition to the lithium,
which one of the following medications might the physician prescribe?
A. Diazepam (Valium)
B. Haloperidol (Haldol)
C. Sertraline (Zoloft)
D. Alprazolam
(Xanax) Answer: B
Explanation:
(A) Diazepam is an antianxiety medication and is not designed to reduce psychotic
symptoms. (B) Haloperidol is an antipsychotic medication and may be used until
the lithium takes effect. (C) Sertraline is an antidepressant and is used primarily to
reduce symptoms of depression. (D) Alprazolam is an antianxiety medication and is
not designed to reduce psychotic symptoms.
NO.5 A violent client remains in restraints for several hours. Which of the following
interventions is most appropriate while he is in restraints?
A. Give fluids if the client requests them.
B. Assess skin integrity and circulation of extremities before applying restraints
and as they are removed.
C. Measure vital signs at least every 4 hours.
D. Release restraints every 2 hours for client to exercise.
Answer: D
Explanatio
n:
(A) Fluids (nourishment) should be offered at regular intervals whether the client
requests (or refuses) them or not. (B) Skin integrity and circulation of the extremities
should be checked regularly while the client is restrained, not only before restraints
are applied and
after they are removed. (C) Vital signs should be checked at least every 2 hours. If the
client remains agitated in restraints, vital signs should be monitored even more
closely, perhaps every 1-2 hours. (D) Restraints should be released every 2 hours for
exercise, one extremity at a time, to maintain muscle tone, skin and joint integrity, and
4
2023/2024 WITH CORRECT VERIFIED AND EXPLAINED
ANSWERS TOP RANKED A+ FOR SUCCESS
Exam : NCLEX-RN
Title : National Council Licensure
Examination(NCLEX-RN)
Vendor : NCLEX
Version : V12.35
1
,NCLEX RN EXAM QUESTIONS AND ANSWERS LATEST UPDATE
2023/2024 WITH CORRECT VERIFIED AND EXPLAINED
ANSWERS TOP RANKED A+ FOR SUCCESS
NO.1
The primary focus of nursing interventions for the child experiencing sickle cell crisis is
aimed toward:
A. Maintaining an adequate level of hydration
B. Providing pain relief
C. Preventing infection
D. O2 therapy Answer: A Explanation:
(A) Maintaining the hydration level is the focus for nursing intervention because
dehydration enhances the sickling process. Both oral and parenteral fluids are used. (B)
The pain is a result of the sickling process. Analgesics or narcotics will be used for
symptom relief, but the underlying cause of the pain will be resolved with hydration.
(C) Serious bacterial infections may result owing to splenic dysfunction. This is true at
all times, not just during the acute period of a crisis. (D) O2 therapy is used for
symptomatic relief of the hypoxia resulting from the sickling process. Hydration is the
NO.2
A 29-year-old client delivered her fifth child by the Lamaze method and developed a
postpartal hemorrhage in the recovery room. What are the initial symptoms of shock
that she may experience?
A. Marked elevation in blood pressure, respirations, and pulse
B. Decreased systolic pressure, cold skin, and anuria
C. Rapid pulse; narrowed pulse pressure; cool, moist skin
D. No urinary output, tachycardia, and restlessness
Answer: C Explanation:
(A) Early shock does not exhibit the symptom of marked elevation in blood pressure. A
narrowing of the pulse pressure is indicative of early shock. (B) Anuria is a clinical finding
in late shock. (C) All of these clinical findings are congruent with early shock. (D) Absence
2
,NCLEX RN EXAM QUESTIONS AND ANSWERS LATEST UPDATE
2023/2024 WITH CORRECT VERIFIED AND EXPLAINED
ANSWERS TOP RANKED A+ FOR SUCCESS
of urinary output is a clinical finding in the late phase of shock.
NO.3 A 24-year-old client presents to the emergency department protesting "I am God."
The nurse identifies this as a:
A. Delusion
B. Illusion
C. Hallucination
D. Conversi
on Answer:
A
Explanation
:
(A) Delusion is a false belief. (B) Illusion is the misrepresentation of a real, external
sensory experience. (C) Hallucination is a false sensory perception involving any of the
senses. (D) Conversion is the expression of intrapsychic conflict through sensory or
motor manifestations.
NO.4 In acute episodes of mania, lithium is effective in 1-2 weeks, but it may take up to
4 weeks, or
3
, NCLEX RN EXAM QUESTIONS AND ANSWERS LATEST UPDATE
2023/2024 WITH CORRECT VERIFIED AND EXPLAINED
ANSWERS TOP RANKED A+ FOR SUCCESS
even a few months, to treat symptoms fully. Sometimes an antipsychotic agent is
prescribed during the first few days or weeks of an acute episode to manage severe
behavioral excitement and acute psychotic symptoms. In addition to the lithium,
which one of the following medications might the physician prescribe?
A. Diazepam (Valium)
B. Haloperidol (Haldol)
C. Sertraline (Zoloft)
D. Alprazolam
(Xanax) Answer: B
Explanation:
(A) Diazepam is an antianxiety medication and is not designed to reduce psychotic
symptoms. (B) Haloperidol is an antipsychotic medication and may be used until
the lithium takes effect. (C) Sertraline is an antidepressant and is used primarily to
reduce symptoms of depression. (D) Alprazolam is an antianxiety medication and is
not designed to reduce psychotic symptoms.
NO.5 A violent client remains in restraints for several hours. Which of the following
interventions is most appropriate while he is in restraints?
A. Give fluids if the client requests them.
B. Assess skin integrity and circulation of extremities before applying restraints
and as they are removed.
C. Measure vital signs at least every 4 hours.
D. Release restraints every 2 hours for client to exercise.
Answer: D
Explanatio
n:
(A) Fluids (nourishment) should be offered at regular intervals whether the client
requests (or refuses) them or not. (B) Skin integrity and circulation of the extremities
should be checked regularly while the client is restrained, not only before restraints
are applied and
after they are removed. (C) Vital signs should be checked at least every 2 hours. If the
client remains agitated in restraints, vital signs should be monitored even more
closely, perhaps every 1-2 hours. (D) Restraints should be released every 2 hours for
exercise, one extremity at a time, to maintain muscle tone, skin and joint integrity, and
4
