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NCSBN NCLEX QUESTIONS.
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NCSBN NCLEX QUESTIONS.
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NCSBN NCLEX QUESTIONSA 12 year-old child, admitted with a broken arm, is waiting for a scheduled surgery. The
nurse finds the child crying and unwilling to talk. What would be the most appropriate
initial response by the nurse?
1Reassure the child that the surgery will go fine with no problems
2Provide privacy with encouragement to work through feelings
3Distract the child with a choice of activities to do while waiting for surgery
4Make arrangements for friends to visit as soon as possible - ANS-2
A 14 month-old child ingests a half a bottle of baby aspirin (81 mg) tablets. Which
finding should a nurse expect to see in the child?
1Hypothermia
2Nausea and vomiting
3Hypoventilation
4Bradycardia - ANS-2
A 16 month-old child has just been admitted to the hospital. As the nurse assigned to
this child enters the hospital room for the first time, the toddler runs to the mother, clings
to her and begins to cry. What should be the next action of the nurse?
1Arrange to change client-care assignments
2Discuss with the parent the appropriate use of "time-out"
3Explain to the mother that the child needs extra attention
4Explain to the parent that this behavior is expected - ANS-4
A 2 day-old infant born with spina bifida and meningomyocele is recovering after an
initial surgery. As the nurse accompanies the grandparents for their first visit since the
child's birth, which of these responses might the nurse expect from the grandparents?
1Anger
2Disbelief
3Depression
4Frustration - ANS-2
A 2-year-old child is brought to the pediatrician's office by the parents, who report that
the child has been having diarrhea for two days. What nutritional information should the
nurse provide to the parents?
1Keep the child fasting, give them nothing to eat, and return the next day.
2Give the child only clear liquids and gelatin for 24 hours.
3Continue a regular diet and add electrolyte replacement drinks.
,4Give the child bananas, apples, rice and toast as tolerated. - ANS-3
A 20-year-old male client who has a profuse, purulent urethral discharge with painful
urination is seen at a community health clinic. Which information will be most important
for the nurse to obtain?
1Sexual orientation
2Recent sexual contacts
3Immunization history
4Contraceptive preference - ANS-2
A 28-year-old is transferred to the emergency department (ED) via ambulance with a
traumatic head injury. The client is awake and reports having a headache and some
amnesia. What are the priority nursing interventions for this client? (Select all that
apply.) - ANS-Correct Response
Assess vital signs and neurological function
Assess the airway
Prepare for CT imaging of the head
Assess the wound for presence of drainage or bruising on the head
A 3 year-old child is brought to the health clinic. The grandmother reports that the child
is always "scratching his bottom" and is "extremely irritable." Based on this information,
which health issue would the nurse assess for initially?
1Pinworm
2Scabies
3Ringworm
4Allergies - ANS-1
A 6 month-old infant is being treated for developmental hip dysplasia and has been
placed in a hip spica plaster cast. Which discharge information is important for the nurse
to reinforce with the parents?
1Turn the baby every two hours using the abduction stabilizer bar
2Check frequently for swelling in the baby's feet
3Gently rub the skin with a cotton swab to relieve itching
4Place favorite books and push-pull toys in the crib - ANS-2
A 6 year-old child is hospitalized with findings of moderate edema, gross hematuria and
mild hypertension associated with the diagnosis of acute glomerulonephritis (AGN).
Which nursing intervention would be appropriate for this client?
1Weigh the child twice per shift
2Relieve boredom through physical activity
,3Institute seizure precautions
4Encourage the child to eat protein-rich foods - ANS-3
A 68-year-old, postmenopausal, female client has been prescribed tamoxifen for breast
cancer with bone metastases. The nurse should reinforce teaching about which
potential adverse drug effect?
1Stroke-like symptoms
2Seizures
3Symptoms of hypocalcemia
4Insomnia - ANS-1
Tamoxifen is an antineoplastic drug, commonly prescribed for clients with breast cancer
or for clients who are at high risk for developing breast cancer. The most common
adverse drug effects (ADEs) are hot flashes, fluid retention, vaginal discharge, nausea,
vomiting and menstrual irregularities. In women with bone metastases, tamoxifen may
cause transient hypercalcemia. Because of its estrogen agonist actions, tamoxifen
poses a small risk of thromboembolic events, including deep vein thrombosis,
pulmonary embolism and stroke.
A child diagnosed with thalassemia has received several blood transfusions during the
past three days. What lab value is the priority for the nurse to monitor with this client?
1Hemoglobin level
2Platelet count
3Blood urea nitrogen level
4Neutrophil percentage - ANS-1
A normal hemoglobin range for children is approximately 11 to 13 gm/dL. Thalassemia,
also called Cooley's anemia, is a genetic defect that causes anemia, i.e., a condition in
which the blood contains below-normal hemoglobin levels. Hemoglobin is the
oxygen-carrying protein component of the red blood cell (RBC).
A child has severe burns to the lower extremities. A diet high in protein and
carbohydrates is recommended. The nurse should care for this client with the
knowledge that the most important reason for such a diet is to achieve which result?
1Provide a well-balanced nutritional intake
2Promote healing and strengthen the immune system
3Spare protein catabolism to meet metabolic and healing needs
4 stimulate increased peristalsis and nutrient absorption - ANS-3
A child is admitted to the hospital for emergency surgery. The child's parent reports
several allergies. Which of these allergies should all the operative health care personnel
be notified about?
, 1Perfumed soap
2Shellfish
3Balloons
4Mold - ANS-3
A child is admitted to the unit with the suspected diagnosis of pertussis (whooping
cough). What is the priority nursing intervention for this child?
1. Maintain hydration and encourage fluids
2. Implement droplet precautions
3. Monitor respiratory rate and oxygen saturation
4. Anti- infective therapy - ANS-2
A client at risk for a stroke has been prescribed clopidogrel. Which information is most
important for the nurse to reinforce with the client?
1"You must take the medication on an empty stomach."
2"If you miss a dose, take a double dose the next day."
3"You must have your lab tests checked weekly."
4"You must stop the medication a week before your surgery." - ANS-4
Clopidogrel is an oral antiplatelet drug with similar effects to aspirin. The drug is taken
for secondary prevention of myocardial infarction, ischemic stroke and other vascular
events. Clopidogrel prevents platelet aggregation. Like all other antiplatelet drugs,
clopidogrel poses a risk of serious bleeding. Clopidogrel should be discontinued 5 to 7
days before elective surgery.
A client becomes acutely short of breath with an SpO2 (oxygen saturation) of 82%.
Which oxygen delivery system should the nurse apply that would provide the highest
concentrations of oxygen to the client?
1Simple face mask
2Partial rebreather mask
3Venturi mask
4Non-rebreather mask - ANS-4
A client comes to the community health clinic with symptoms of gonorrhea. Which
intervention should the nurse implement first?
1Discuss the risk of infertility with the client.
2Collect a urethral swab from the client.
3Instruct the client to notify past sexual partners.
4Obtain information about the client's recent sexual encounters. - ANS-4
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