Changing the Concept of NCLEX-RN Exam Preparation 2023
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Preparing for the NCLEX-RN exam is a significant undertaking, and many nursing graduates spend months studying and preparing for the exam. There are many resources available to help nursing graduates prepare for the exam, including review books, study guides, and online practice exams. Many nursing programs also offer NCLEX-RN preparation courses to help their students prepare for the exam.
NEW QUESTION # 13
What is the most effective method to identify early breast cancer lumps?
- A. Yearly checkups performed by physician
- B. Mammograms every 3 years
- C. Monthly breast self-examination
- D. Ultrasounds every 3 years
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) Mammograms are less effective than breast self-examination for the diagnosis of abnormalities in younger women, who have denser breast tissue. They are more effective forwomen older than 40. (B) Up to 15% of early-stage breast cancers are detected by physical examination; however, 95% are detected by women doing breast self-examination. (C) Ultrasound is used primarily to determine the location of cysts and to distinguish cysts from solid masses. (D) Monthly breast self-examination has been shown to be the most effective method for early detection of breast cancer. Approximately 95% of lumps are detected by women themselves.
NEW QUESTION # 14
A client is scheduled for a magnetic resonance imaging (MRI) to locate a cerebral lesion. It is important for the nurse to find out if he has a(n):
- A. Movable metal implant
- B. History of seizures
- C. Allergy to seafood
- D. Pin or screw in any bone
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Iodine is not used as a contrast medium for MRI. It is important to inquire about allergy to seafood if the client is to have an arteriogram or enhanced computer tomography. (B) MRI is safe if seizures are under control. It is more important to inquire about movable metal implants. (C) Clients with movable metal implants such as shrapnel or aneurysm clips or clients with permanent pacemakers or implanted pumps can be traumatized during an MRI. (D) Nonmovable metal prostheses or hardware will not cause trauma during an MRI.
NEW QUESTION # 15
A 26-year-old client is diagnosed with an astrocytoma, a benign brain tumor. From the nurse's knowledge of the central nervous system, the nurse knows that benign tumors:
- A. Grow more rapidly than malignant tumors
- B. Can be just as dangerous as malignant tumors
- C. Can be removed surgically
- D. Do not warrant concern because they do not become malignant tumors
Answer: B
Explanation:
Explanation
(A) Both a benign and a malignant tumor can displace or destroy nearby structures or increase intracranial pressure. (B) Benign or malignant brain tumors grow at different rates depending on the type of tumor. (C) Some benign tumors do become malignant tumors. (D) Whether or not a tumor is operable depends on its location and the amount of damage its removal will cause.
NEW QUESTION # 16
During his hospitalization, a 3-year-old child has become unusually aggressive in his play activities. His parents report this change in behavior to the primary nurse. How could the nurse explain the child's change in behavior?
- A. A lack of interest in socializing
- B. Deep-seated feelings of hostility
- C. A coping response
- D. Usual behavior for this child
Answer: C
Explanation:
Explanation
(A) Unusually aggressive behavior does not indicate a deepseated problem. (B) A lack of social interest results in poor participation in play activities with peers. Aggression would not be an expected behavior. (C) The aggressive behavior was newly developed and not a routine behavior. (D) Play provides the child with opportunities for coping and adaptation. Aggression during the play activities would indicate a coping response.
NEW QUESTION # 17
A murmur has been discovered during the routine physical examination of a 1-year-old child. The parent is extremely concerned about this diagnosis. Which of the following explanations by the nurse indicates understanding of this dysfunction?
- A. Surgical closure by suture or patch is recommended before school age.
- B. The blood shifts from the right to the left atrium.
- C. The child can be treated medically with antibiotics to prevent bacterial endocarditis.
- D. Most atrial septal defects close spontaneously.
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Because the left atrial pressure is greater than right atrial pressure, oxygenated blood flows from the left to the right atria. (B) Because of the risk of pulmonary obstructive diseases and congestive heart failure later in life, surgery is usually performed between age 4 and 6 years, with essentially no operative mortality or postoperative complications. (C) Many ventricular septal defects close spontaneously (20-60%) as a result of growth and proliferation of the muscular septum or formation of a membrane across the opening.
(D) This management is usually recommended with children with mild pulmonary stenosis.
NEW QUESTION # 18
A 13-year-old hemophiliac is hospitalized for hemarthrosis of his right knee. To relieve the pain, the nurse should:
- A. Apply moist heat to the right knee
- B. Administer aspirin for pain
- C. Encourage active range of motion to right knee
- D. Place on bed rest; elevate and splint the right knee
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Immobilization, splinting, and bed rest will reduce the bleeding. Once bleeding is reduced or stopped, the pain will subside. (B) Moist heat causes vasodilation and bleeding. Ice or cold compresses should be applied. (C) Aspirin decreases platelet aggregation, which causes bleeding. (D) Active range of motion aggravates bleeding and damages the synovial sac during bleeding episodes.
NEW QUESTION # 19
The nurse working with a client who is out of control should follow a model of intervention that includes which of the following?
- A. Leave the aggressive client to himself or herself, and take other clients away.
- B. Challenge client's behavior immediately with steps to prevent injury to self or others.
- C. Approach the client on a continuum of least restrictive care.
- D. To ensure safety of other clients, place client in seclusion immediately when he or she begins shouting.
Answer: C
Explanation:
(A) Approaching a client's aggressive behavior on a continuum of least restrictive care is in agreement with his or her rights (i.e., verbal methods to help maintain control, medication, seclusion, and restraints, as necessary). (B) Approaching a client in a challenging manner is threatening and inappropriate. A nonchallenging and calm approach reflects staff in control and may increase client's internal control. (C) It is inappropriate to leave an aggressive client who is acting out alone. The nurse should acquire qualified help to prevent client from harm or injury to self or others. (D) Moving a client to seclusion immediately for shouting is inappropriate. The nurse should offer the client an opportunity to control self with limit setting. The client should understand that the staff will assist with control if necessary (i.e., quietly accompany out of environment to decrease stimulation and allow for verbalization) employing the least restrictive care model of intervention.
NEW QUESTION # 20
A client in active labor asks the nurse for coaching with her breathing during contractions. The client has attended Lamaze birth preparation classes. Which of the following is the best response by the nurse?
- A. "Make sure you take a deep cleansing breath as the contractions start, focus on an object, and breathe about 16-20 times a minute with shallow chest breaths."
- B. "Find a comfortable position before you start a contraction. Once the contraction has started, take slow breaths using your abdominal muscles."
- C. "If a woman in labor listens to her body and takes rapid, deep breaths, she will be able to deal with her contractions quite well."
- D. "Keep breathing with your abdominal muscles as long as you can."
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Lamaze childbirth preparation teaches the use of chest, not abdominal, breathing. (B) In Lamaze preparation, every patterned breath is preceded by a cleansing breath; as labor progresses, shallow, paced breathing is found to be effective. (C) It is important to assume a comfortable position in labor, but the Lamazeprepared laboring woman is taught to breathe with her chest, not abdominal, muscles. (D) When deep chest breathing patterns are used in Lamaze preparation, they are slowly paced at a rate of 6-
9 breaths/min.
NEW QUESTION # 21
A client is experiencing muscle weakness and lethargy. His serum K+is 3.2. What other symptoms might he exhibit?
- A. Dysrhythmias
- B. Headache
- C. Tetany
- D. Numbness of extremities
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Tetany is seen with low calcium. (B) Low potassium causes dysrhythmias because potassium is responsible for cardiac muscle activity. (C) Numbness of extremities is seen with high potassium. (D) Headache is not associated with potassium excess or deficiency.
NEW QUESTION # 22
A female client who has chronic obstructive pulmonary disease (COPD) has presented in the emergency department with cough productive of yellow sputum and increasing shortness of breath. On room air, her blood gases are as follows: pH 7.30 mm Hg, PCO2 60 mm Hg, PO2 55 mm Hg, HCO3 32 mEq/L. These arterial blood gases reflect:
- A. Normal blood gases
- B. Compensated respiratory acidosis
- C. Uncompensated respiratory acidosis
- D. Uncompensated metabolic acidosis
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) In compensated respiratory acidosis, the pH level is normal, the PCO2level is elevated, and the HCO3level is elevated. The client's primary alteration is an inability to remove CO2from the lungs, so over time, the kidneys increase reabsorption of HCO3to buffer the CO2. (B) Normal ranges for arterial blood gases for adults and children are as follows: pH 7.35-7.45, PO280-100 mm Hg, PCO235-45 mm Hg, HCO321-28 mEq/L. (C) In uncompensated metabolic acidosis the pH level is decreased, the PCO2level is normal, and the HCO3level is decreased. The client's primary alteration is an inability to remove excess acid via the kidneys. The lungs are unable to clear the increased acid. (D) In uncompensated respiratory acidosis, the pH level is decreased, the PCO2level is increased, and the HCO3level is normal. In a person with long-standing COPD, the HCO3level will rise gradually over time to compensate for the gradually increasing PCO2, and the person's pH level will be normal. When a person with COPD becomes acutely ill, the kidneys do not have time to increase the reabsorption of HCO3, so the person's pH level will reflect acidosis even though the HCO3is elevated.
NEW QUESTION # 23
A 19-year-old male client arrived via ambulance to the emergency room following a motorcycle accident. He is comatose. His face has evidence of dried blood. On assessment, the nurse notes an obvious injury to his left eye. The preferred positioning for a client with an obvious eye injury is:
- A. Reclining to control bleeding
- B. Sitting with head support
- C. Any position in which the client is comfortable
- D. Side-lying, either left or right
Answer: B
Explanation:
Explanation
(A) A reclining position can cause a penetrating object to advance further into the eye. (B) Prevention of further injury is the priority, not comfort. (C) A side-lying position may increase intraocular and intracranial pressure if an accompanying head injury is suspected. (D) A sitting position with the head supported will prevent further injury while allowing injury care to take place.
NEW QUESTION # 24
A client is to have a coronary artery bypass graft performed in the morning using a saphenous vein. He wants to know why the physician does not use the internal mammary artery for his bypass graft because his friend's physician uses this artery. The nurse tells the client that the internal mammary artery:
- A. Has too many valves
- B. Has a greater risk of becoming reoccluded
- C. Is smaller in diameter
- D. Takes more time to remove
Answer: D
Explanation:
(A) It does take more time to remove the internal mammary artery, and this is one reason why some physicians do not use it. (B) There is not a greater risk of reocclusion. In fact, it may actually stay patent longer. (C) The internal mammary artery is actually larger in diameter than the saphenous vein. (D) The internal mammary artery does not have too many valves.
NEW QUESTION # 25
A client with bipolar disorder taking lithium tells the nurse that he has ringing in his ears, blurred vision, and diarrhea. The nurse notices a slight tremor in his left hand and a slurring pattern to his speech. Which of the following actions by the nurse is appropriate?
- A. Request an order for a stat blood lithium level.
- B. Recognize this as an expected response to lithium.
- C. Administer a stat dose of lithium as necessary.
- D. Give an oral dose of lithium antidote.
Answer: A
Explanation:
Section: Questions Set A
Explanation:
(A) These symptoms are indicative of lithium toxicity. A stat dose of lithium could be fatal. (B) These are toxic effects of lithium therapy. (C) The client is exhibiting symptoms of lithium toxicity, which may be validated by lab studies. (D) There is no known lithium antidote.
NEW QUESTION # 26
A pregnant client is at the clinic for a third trimester prenatal visit. During this examination, it has been determined that her fetus is in a vertex presentation with the occiput located in her right anterior quadrant.
On her chart this would be noted as:
- A. Right occipitoposterior
- B. Right occipitoanterior
- C. LOA
- D. Right sacroanterior
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) The fetus in the right occipitoposterior position would be presenting with the occiput in the maternal right posterior quadrant. (B) Fetal position is defined by the location of the fetal presenting part in the four quadrants of the maternal pelvis. The right occipitoanterior is a fetus presenting with the occiput in mother's right anterior quadrant. (C) The fetus in right sacroanterior position would be presenting a sacrum, not an occiput. (D) The fetus in left occipitoanterior position would be presenting with the occiput in the mother's left anterior quadrant.
NEW QUESTION # 27
A 12-year-old girl has been diagnosed with insulindependent diabetes mellitus. Which of these principles would best guide her nutritional management?
- A. Food restriction is imposed to reduce weight.
- B. Fat requirements are increased owing to the possibility of ketoacidosis.
- C. Caloric distribution should be calculated to fit activity patterns.
- D. Concentrated sweets are taken during increased activity.
Answer: C
Explanation:
(A) Concentrated sweets are eliminated from diet planning. Complex carbohydrates may be taken at the time of increased activity. (B) Food restriction is not used for diabetic control of growing children. Caloric restriction may be imposed for weight control if necessary. (C) Total caloric intake and proportions of basic nutrients should be consistent from day to day. Distribution of these calories should fit the activity pattern. Extra food is needed for increased activity. A balance of food, exercise, and insulin should be maintained. (D) Because of the increased risk of atherosclerosis, the fat percentage of the total caloric intake is reduced.
NEW QUESTION # 28
A client delivered a stillborn male at term. An appropriate action of the nurse would be to:
- A. Provide an opportunity for the parents to see and hold the baby for an undetermined amount of time.
- B. Reassure the parents that they can have other children.
- C. State, "You have an angel in heaven."
- D. Discourage the parents from seeing the baby.
Answer: A
Explanation:
Section: Questions Set G
Explanation:
(A) This is not a supportive statement. There are also no data to indicate the family's religious beliefs. (B) Seeing their baby assists the parents in the grieving process. This gives them the opportunity to say "good- bye." (C) Parents need time to get to know their baby. (D) This is not a comforting statement when a baby has died. There are also no guarantees that the couple will be able to have another child.
NEW QUESTION # 29
A 5-year-old child was recently diagnosed as having acute lymphoid leukemia. She is hospitalized for additional tests and to begin a course of chemotherapy designed to induce a remission. She is scheduled to have a bone marrow aspiration tomorrow. She has had a bone marrow test previously and is apprehensive about having another. Which of the following interventions will be most effective in relieving her anxiety?
- A. Give her a big hug and tell her that she is a big girl now and that she will do just fine.
- B. Explain what will take place and what she will see, feel, and hear.
- C. Remind her that she has had this procedure before and that it is nothing to be afraid of.
- D. Tell her not to worry about it, that it will be over soon and she can join her friends in the playroom.
Answer: B
Explanation:
(A)
Even though the child has had the procedure before, she will probably need additional explanations and emotional support. (B) The fact that the child has had the procedure before and possibly found it painful or uncomfortable may increase, not relieve, her stress.
(C)
This intervention does nothing to reassure the child and may well prevent her from expressing her feelings. (D) This does not prepare the child for the test and burdens her with the expectation that she act bigger and braver than she is.
NEW QUESTION # 30
A client had a ruptured abdominal aortic aneurysm that was repaired surgically. Her postoperative recovery progressed without complications, and she is ready for discharge. Client education in preparation for discharge began 7 days ago on her admission to the nursing unit. Evaluation of nursing care related to client education is based on evaluation of expected outcomes. Which statement made by the client would indicate that she is ready for discharge?
- A. "Teach my husband about the diet. He'll be doing all the cooking now."
- B. "I am allowed to exercise by walking for short periods."
- C. "I will not drive but ride in the front seat of the car with a seat belt on for my first doctor's appointment."
- D. "When I bathe tomorrow morning, I will be very careful not to get soap on my incision."
Answer: B
Explanation:
(A) Postoperatively, clients with major abdominal surgery are instructed to avoid driving, riding in the front seat, and wearing seat belts because any sudden impact may injure a fresh incision. She should ride in back seat without a seat belt. (B) Clients should not sit in the tub and allow the incision to soak in water because this may predispose the client to infection. A short, cool shower would be preferable. Allowing soap to come in contact with the incision would not harm it and is frequently used as postoperative wound care at home on discharge from the hospital. (C) Activity instructions include: avoid sitting for long periods and get exercise by walking. Lifting more than 5 lb of weight is also prohibited. (D) The client must also learn her diet. Her husband cooking is probably a temporary measure unless he did the cooking prior to her hospitalization.A statement such as this may indicate the need for further exploration of feelings regarding her illness, dependence, and self-care expectations.
NEW QUESTION # 31
A term neonate has experienced no distress at birth and has an Apgar score of 9. Her mother has asked to breastfeed her following delivery. Immediately after birth, the neonate was most susceptible to heat loss. The most appropriate intervention to conserve heat loss and promote bonding is to:
- A. Place her on a heated pad
- B. Dry her with blankets
- C. Place her to her mother's breast
- D. Place her under the radiant warmer
Answer: C
Explanation:
(A) A radiant warmer maintains an optimal thermal environment by use of a thermal skin sensor taped to the infant. The warmer limits parental attachment, so, although appropriate, it is not an intervention that promotes infant attachment. (B) Warmed blankets prevent heat loss in the neonate by conduction. In addition, tactile stimuli promote crying and lung expansion. This intervention does not promote attachment, however. (C) Skin-toskin contact is an effective way to conserve heat after delivery and promotes parental attachment following birth in the healthy term infant. The first period of reactivity lasts approximately 30 minutes following birth. A strong sucking reflex and an active, awake newborn characterize this period. (D) Surfaces of objects warmer than the infant promote overheating by conduction, and neonatal hyperthermia may result.
NEW QUESTION # 32
Following the delivery of a healthy newborn, a client has developed thrombophlebitis and is receiving heparin IV. What are the signs and symptoms of a heparin overdose for which the nurse would need to observe during postpartum care of the client?
- A. Hematuria, ecchymosis, and epistaxis
- B. Dysuria
- C. Vertigo, hematuria, ecchymosis
- D. Epistaxis, hematuria, dysuria
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Dysuria is not a common symptom of heparin overdose. (B) Although epistaxis and hematuria are common symptoms of heparin overdose, dysuria is not. (C) Vertigo is not a common symptom of heparin overdose. (D) Hematuria, ecchymosis, and epistaxis are the most common signs and symptoms of a heparin overdose. Others are thrombocytopenia, elevated liver enzymes, and local injection site complications.
NEW QUESTION # 33
A newborn is admitted to the newborn nursery with tremors, apnea periods, and poor sucking reflex. The nurse should suspect:
- A. Central nervous system damage
- B. Hypoglycemia
- C. Hyperglycemia
- D. These are normal newborn responses to extrauterine life
Answer: B
Explanation:
(A) Central nervous system damage presents as seizures, decreased arousal, and absence of newborn reflexes. (B) In a diabetic mother, the infant is exposed to high serum glucose. The fetal pancreas produces large amounts of insulin, which causes hypoglycemia after birth. (C) Hypoglycemia is a common newborn problem. Increased insulin production causes hypoglycemia, not hyperglycemia. (D) These are not normal adaptive behaviors to extrauterine life.
NEW QUESTION # 34
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