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RN NCLEX QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS GRADED A+
Terms in this set (143)
A nurse is caring for an older adult client A, B, D, E
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 client compliance?
(SATA)
A. Ask the dietitian to assist with
meal planning
B.Contact the client'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
A client with diabetes mellitus has a D
glycosylated hemoglobin A1c level of 8%.
On the basis of this test result, the nurse Rationale:
plans to teach the client about the need for The normal reference range for the glycosylated hemoglobin A1c is less than 6.0%.
which measure? 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,
A. Avoiding infection giving feedback about blood glucose for the past 120 days. Elevations in the blood
B. Taking in adequate fluids glucose level will cause elevations in the amount of glycosylation. Thus, the test is
C. Preventing and recognizing useful in identifying clients who have periods of hyperglycemia that are
hypoglycemia undetected in other ways. The estimated average glucose for a glycosylated
D.Preventing and recognizing hemoglobin A1c of 8% is 205 mg/dL (11.42 mmol/L). Elevations indicate continued
hyperglycemia need for teaching
related to the prevention of hyperglycemic episodes.
A
The nurse is instructing a client how to
perform a testicular self-examination (TSE).
Rationale:
The nurse should explain that which is the
The nurse needs to teach the client how to perform a TSE. The nurse should instruct
best time to perform this exam?
the client to perform the exam on the same day each month. The nurse should also
instruct the client that the best time to perform a TSE is after a shower or bath when
A. After a shower or bath
the hands are warm and soapy and the scrotum is warm. Palpation is easier and the
B.While standing to void
client will be better able to identify any abnormalities. The client would stand to
C. After having a bowel movement
perform the exam, but it would be difficult to perform the exam while voiding.
D.While lying in bed before arising
Having a bowel movement is unrelated to performing a TSE.
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The clinic nurse prepares to perform a A, B, D
focused assessment on a client who is
complaining of symptoms of a cold, Rationale:
a A focused assessment focuses on a limited or short-term problem, such as the
cough, and lung congestion. Which should client's complaint. Because the client is complaining of symptoms of a cold, a cough,
the nurse include for this type of and lung congestion, the nurse would focus on the respiratory system and the
assessment? Select all that apply. presence of an infection. A complete assessment includes a complete health history
and physical examination and forms a baseline database. Assessing the strength of
A. Auscultating lung sounds peripheral pulses relates to a vascular assessment, which is not related to this client's
B.Obtaining the client's temperature complaints. A musculoskeletal and neurological examination also is not related
C. Assessing the strength of peripheral to
pulses this client's complaints. However, strength of peripheral pulses and a
D.Obtaining information about the musculoskeletal and neurological examination would be included in a complete
client's respirations assessment.
E. Performing a musculoskeletal Likewise, asking the client about a family history of any illness or disease would be
and neurological examination included in a complete assessment.
F. Asking the client about a family
history of any illness or disease
The clinic nurse is preparing to explain the D
concepts of Kohlberg's theory of moral
development with a parent. The nurse Rationale:
should tell the parent that which factor In the preconventional stage, morals are thought to be motivated by punishment
motivates good and bad actions for the and reward. If the child is obedient and is not punished, then the child is being
child at the preconventional level? moral. The child sees actions as good or bad. If the child's actions are good, the
child is praised.
A. Peer pressure If the child's actions are bad, the child is punished. Options 1, 2, and 3 are not
B.Social pressure associated factors for this stage of moral development.
C. Parents' behavior
D.Punishment and reward
The maternity nurse is providing A
instructions to a new mother regarding the
psychosocial development of the Rationale:According to Erikson, the caregiver should not try to anticipate the
newborn infant. Using Erikson's newborn infant's needs at all times but must allow the newborn infant to signal
psychosocial needs. If a newborn infant is not allowed to signal a need, the newborn will not learn
development theory, the nurse instructs the how to control the environment. Erikson believed that a delayed or prolonged
mother to take which measure? response to a newborn infant's signal would inhibit the development of trust and
lead to mistrust of others.
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.
A nursing student is presenting a clinical A
conference to peers regarding Freud's
psychosexual stages of development, Rationale:
specifically the anal stage. The student In general, toilet training occurs during the anal stage. According to Freud, the child
explains to the group that which gains pleasure from the elimination of feces and from their retention. Option 2
characteristic relates to the anal stage? relates to the oral stage. Option 3 relates to the latency period. Option 4 relates to
the phallic stage.
A. This stage is associated with toilet
training.
B. This stage is
characterized by the gratification
of self.
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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.
The nurse is describing Piaget's cognitive A
developmental theory to pediatric nursing
staff. The nurse should tell that staff that Rationale:
which child behavior is characteristic of the In the formal operations stage, the child has the ability to think abstractly and
formal operations stage? logically. Option 2 identifies the sensorimotor stage. Option 3 identifies the concrete
operational stage. Option 4 identifies the preoperational 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.
The mother of an 8-year-old child tells the C
clinic nurse that she is concerned about the
child because the child seems to be more Rationale:According to Erikson, during school-age years (6 to 12 years of age), the
attentive to friends than anything else. child begins to move toward peers and friends and away from the parents for
Using Erikson's psychosocial development support. The child also begins to develop special interests that reflect his or her own
theory, the nurse should make which developing personality instead of the parents'. Therefore, options 1, 2, and 4 are
response? incorrect responses.
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."
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