NCLEX Questions for 2024: A Comprehensive Guide for Nursing Students, Exams of Nursing

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NEW GENERATION NCLEX QUESTIONS FOR 2024

EXAM;; HIGHLY RATED // GUARANTEED PASS

A client is in the eighth month of pregnancy. To enhance cardiac output and renal function, the nurse should advise her to use which body position? - ANSWER Left lateral During her fourth clinic visit, a client who's 5 months pregnant tells the nurse she was exposed to rubella during the past week and asks whether she can be immunized now. How should the nurse respond? - ANSWER No. Because the live viral vaccine is contraindicated during pregnancy. A client and her spouse, both 25 years old, are having trouble conceiving. Infertility in this couple is defined as: - ANSWER inability to conceive after 1year of unprotected attempts. When evaluating a pregnant client's fundal height, the nurse should measure in which way? - ANSWER from symphysis pubis notch to highest level of fundus. Which of the following client statements indicates the need for further teaching about percutaneous umbilical blood sampling (PUBS) to assess fetal hemoglobin and hematocrit? - ANSWER "I will lie on my back in a cylinder-type machine." When explaining the risk for having a child with cystic fibrosis to a husband and wife, the nurse should tell them: - ANSWER the risk is greatest when both clients have the recessive gene. A nurse is caring for a client whose membranes ruptured prematurely 12 hours ago. When assessing this client, the nurse's highest priority is to evaluate: - ANSWER maternal vital signs and fetal heart rate (FHR). A 34-year-old multiparous client at 16 weeks' gestation who received regular prenatal care for all of her previous pregnancies tells the nurse that she has already felt the baby move. How does the nurse interpret this finding? - ANSWER normal because multiparous clients can experience quickening between 14 and 20 weeks' gestation

When developing the plan of care for a multigravid client with class III heart disease, the nurse should expect to assess the client frequently for which problem? - ANSWER Tachycardia A client at 37 weeks gestation is at a prenatal visit and states that she sometimes feels dizzy when lying directly on her back. Which of the following is the nurse's best response? - ANSWER "This may be due to the uterus putting pressure on a blood vessel." A client is a 43-year-old G2 P1 at 16 weeks' gestation that has completed prenatal testing for chromosomal abnormalities. The results reveal the infant is a female with Down syndrome. The parents are seeking information about this syndrome. What should the nurse tell the parents? Select all that apply. - ANSWER • Down syndrome can occur in mothers of any age.

• Down syndrome occurs more frequently with advanced maternal age.
• Down syndrome results from a trisomy of chromosome 21. Which task may a nurse delegate to a nursing assistant? - ANSWER Assisting a client who had surgery to ambulate in the hallway A client admitted with acute anxiety has the following arterial blood gas (ABG) values: pH, 7.55; partial pressure of arterial oxygen (PaO2), 90 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 27 mm Hg; and bicarbonate (HCO3-), 24 mEq/L. Based on these values, the nurse suspects: - ANSWER respiratory alkalosis. A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: - ANSWER a positive edrophonium test. A nurse is caring for a client admitted to the unit with a seizure disorder. The client seems upset and asks the nurse, "What will they do to me? I'm scared of the tests and of what they'll find out." The nurse should focus her teaching plans on which diagnostic tests? - ANSWER EEG, blood cultures, and neuroimaging studies A client with schizophrenia comes to the outpatient mental health clinic 5 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. The client tells the nurse that she has too much saliva and frequently needs to spit. The nurse interprets the client's statement as being consistent with which factor? - ANSWER expected adverse effect of clozapine

The nurse-manager of an outpatient facility isn't satisfied with discharge planning policies and procedures. Knowing other managers at similar facilities regarded as the "best" in the country, which steps should the nurse-manager take as part of a continuous quality-improvement process? - ANSWER Contact the nurse-managers at the best facilities and compare their discharge planning policies and procedures with those of her facility. Benchmarking is a good approach for the nurse-manager to take. Benchmarking is the process of comparing an organization's delivery of client care practices in one organization to those in the best health care organizations. A client is in the 38th week of her first pregnancy. She calls the prenatal facility to report occasional tightening sensations in the lower abdomen and pressure on the bladder from the fetus, which she says seems lower than usual. The nurse should take which action? - ANSWER Review premonitory signs of labor with the client. Because the client is describing two premonitory signs of labor, Braxton Hicks contractions and tightening, the nurse should review these normal signs and reassure the client. The nurse is caring for a client in the recovery room after electroconvulsive therapy (ECT). Which of the following would be the priority nursing assessment? - ANSWER Vital signs. Headache, disorientation, and memory loss are common short-term side effects, but the priority assessment would be client vital signs in the postictal state. The nurse would not be able to assess the client's response to ECT immediately post-procedure. The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, the nurse should assess the client for: - ANSWER Less difficulty breathing. Theophylline is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions. The risk for injury during an attack of Ménière's disease is high. The nurse should instruct the client to take which immediate action when experiencing vertigo? - ANSWER Assume a reclining or flat position." The client needs to assume a safe and comfortable position during an attack, which may last several hours. The client's location when the attack occurs may dictate the most reasonable position. Ideally, the client should lie down immediately in a reclining or flat position to control the vertigo. The danger of a serious fall is real. Placing the head between the knees will not help prevent a fall and is not practical because the attack may last several hours. Concentrating on breathing may be a useful distraction, but it will not help prevent a fall. Closing the eyes does not help prevent a fall. (less)

A nurse is assessing a client with meningitis. The nurse places the client in a supine position and flexes the client's leg at the hip and knee. The nurse notes resistance when straightening the knee and the client reports pain. The nurse should document what neurologic sign as positive? - ANSWER Kernig's sign A positive Kernig's sign is a manifestation of meningeal irritation. The nurse can elicit this sign by placing the client in a supine position and flexing the leg at the hip and knee. Pain or resistance when the knee is straightened suggests meningeal irritation. The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. - ANSWER Compare ABG findings with previous results.

• Maintain intake and output records.
• Document presenting signs and symptoms. Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The result is retention of sodium bicarbonate and increased base bicarbonate. A client is receiving fluid replacement with lactated Ringer's after 40% of the body was burned 10 hours ago. The assessment reveals temperature 97.1° F (36.2° C), heart rate 122 bpm, blood pressure 84/ mm Hg, central venous pressure (CVP) 2 mm Hg, and urine output 25 mL for the last 2 hours. The IV rate is currently at 375 mL/h. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the health care provider (HCP) with a recommendation for:
• ANSWER IV rate increase. The decreased urine output, low blood pressure, low CVP, and high heart rate indicate hypovolemia and the need to increase fluid volume replacement. Furosemide is a diuretic that should not be given due to the existing fluid volume deficit. Fresh frozen plasma is not indicated. It is given for clients with deficient clotting factors who are bleeding. Fluid replacement used for burns is Lactated Ringer's solution, normal saline, or albumin. (less The nurse is caring for a client admitted with pyloric stenosis. A nasogastric tube placed upon admission is on low intermittent suction. Upon review of the morning's blood work, the nurse observes that the patient's potassium is below reference range. The nurse should recognize that the patient may be at risk for what imbalance? - ANSWER Metabolic alkalosis. Probably the most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric fluid is lost. Vomiting, gastric suction, and pyloric stenosis all remove potassium and can cause hypokalemia. This client would not be at risk for hypercalcemia; hyperparathyroidism and cancer account for almost all cases of hypercalcemia. The nasogastric tube is removing stomach acid and will likely raise pH. Respiratory acidosis is unlikely since no change was reported in the client's respiratory status.

why she requires the FSE. What is the nurse's most appropriate response? - ANSWER "The baby needs to be observed more closely. It is not ethical to tell this woman that her baby is "fine." The passage of meconium indicates that the fetus has experienced a stressor in the intrauterine environment, but the severity of the distress cannot be confirmed. The well being of the fetus is not yet known and requires further observation and evaluation with the internal FSE. (less) The nurse assesses a client who is receiving a tube feeding. Which situation would require prompt intervention from the nurse? - ANSWER The feeding that is infusing has been hanging for 8 hours. Feeding solutions that have not been infused after hanging for 8 hours should be discarded because of the increased risk of bacterial growth. Sitting the client upright during the feeding helps prevent aspiration of the feeding. A gastric residual of 25 mL is considered acceptable. A gastric residual of 100 to 150 mL, or a residual greater than 100% of the previous hour's intake, indicates delayed emptying. The feeding solution should be at room or body temperature. The nurse is educating a client on diabetes management. The client is asking questions that cause the nurse to be concerned about the client's ability to retain the information. Which of the following would be the best technique for the nurse to use to enhance the retention of information by the client? - ANSWER Repeat important information during the presentation. Repetition is an effective means of reinforcing critical information and enhancing content retention. The other options will not increase the client's ability to retain information and may decrease the client's concentration and ability to retain critical information. The nurse finds a client lying on the floor next to the bed. After returning the client to bed, assessing for injury, and notifying the health care provider (HCP), the nurse fills out an incident report. What should the nurse do next? - ANSWER Give the incident report to the nurse-manager. A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? - ANSWER Adrenal cortex. Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone. The mother of a client who has a radium implant asks why so many nurses are involved in her daughter's care. She states, "The doctor said I can be in the room for up to 2 hours each day, but the nurses say they

are restricted to 30 minutes." The nurse explains that this variation is based on the fact that nurses: - ANSWER Work with radiation on an ongoing basis, while visitors have infrequent exposure to radiation. The three factors related to radiation safety are time, distance, and shielding. Nurses on radiation oncology units work with radiation frequently and so must limit their contact. Nurses are physically closer to clients than are visitors, who are often asked to sit 6 feet (182.9 cm) away from the client. Touching the client does not increase the amount of radiation exposure. Aseptic technique and isolation prevent the spread of infection. Age is a risk factor for people in their reproductive years. During recovery from a stroke, a client is given nothing by mouth to help prevent aspiration. To determine when the client is ready for a liquid diet, the nurse assesses the client's swallowing ability once per shift. This assessment evaluates: - ANSWER cranial nerves IX and X. Swallowing is a motor function of cranial nerves IX and X. Cranial nerves I, II, and VIII don't possess motor functions. The motor functions of cranial nerve III include extraocular eye movement, eyelid elevation, and pupil constriction. The motor function of cranial nerve V is chewing. Cranial nerve VI controls lateral eye movement. The parent of a 4-year-old expresses concern that the child may be hyperactive. The parent describes the child as always in motion, constantly dropping and spilling things. Which action would be appropriate at this time? - ANSWER Explain that this is not unusual behavior. Preschool-age children have been described as powerhouses of gross motor activity who seem to have endless energy. A limitation of their motor ability is that in moving as quickly as they do, they are not always able to judge distances, nor are they able to estimate the amount of strength and balance needed for activities. As a result, they have frequent mishaps. However, if the behavior intensifies, a referral to a pediatric neurologist would be appropriate. Children who have been abused usually demonstrate withdrawn behaviors, not endless energy. The nurse is working at the local family planning clinic doing family education. When devising a teaching plan, in which client group would the nurse stress the importance of an annual Papanicolaou test? - ANSWER Clients infected with the human papillomavirus (HPV). Annual Papanicolaou testing is a screening to detect potential precancerous and cancerous cells in the endocervical canal of the female reproductive system. HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of oral contraceptives do not increase the risk of cervical cancer. The nurse is providing care for a client with a tracheotomy whose pulse oximeter has recently alarmed, showing the oxygen saturation to be 77%. The nurse has repositioned the client and applied supplemental oxygen, interventions that have raised the oxygen levels to 80% and somewhat decreased

A client is prescribed furosemide to manage heart failure. What laboratory values should the nurse monitor while the client receives this medication? Select all that apply. - ANSWER Serum potassium, and CBC Complete blood count should be monitored, because furosemide can cause agranulocytosis, anemia, leukopenia, and thrombocytopenia. Because loop diuretics such as furosemide promote excretion of potassium, the nurse should also monitor serum potassium levels. Potassium replacement therapy may be necessary to prevent hypokalemia. When preparing the teaching plan for a client about lithium therapy, the nurse should teach the client about: - ANSWER Maintaining an adequate sodium intake. The nurse would teach the client taking lithium and his family about the importance of maintaining adequate sodium intake to prevent lithium toxicity. Because lithium is a salt, reduced sodium intake could result in lithium retention with subsequent toxicity. Increasing sodium in the diet is not recommended and may be harmful. Increased sodium levels result in lower lithium levels. Therefore, the drug may not reach therapeutic effectiveness. The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy? - ANSWER hypopituitarism Most clients who undergo adenoma removal experience a gradual return of normal pituitary secretion and do not experience complications. However, hypopituitarism can cause growth hormone, gonadotropin, thyroid-stimulating hormone, and adrenocorticotropic hormone deficits. The client should be taught to monitor for change in mental status, energy level, muscle strength, and cognitive function. Acromegaly and Cushing's disease are conditions of hypersecretion. A 10-year-old child hospitalized with acute poststreptococcal glomerulonephritis during the acute stage has elevated blood pressure and low urine output for 14 hours. The nurse should next: - ANSWER assess the child's neurologic status. The nurse should assess the child's neurologic status because hypertensive encephalopathy is a major potential complication of the acute phase of glomerulonephritis. Seizure precautions also should be instituted. Hypertensive encephalopathy can result in transient loss of vision, hemiparesis, disorientation, and grand mal seizures. Encouraging the child to drink more water is inappropriate because the child has had a low urine output for 14 hours. Typically, in this situation, fluids would be restricted. Although a low-sodium diet is encouraged, it is not the priority action at this time. Initially, bed rest, not ambulation, is advocated during the acute phase of glomerulonephritis. A boy, age 2, is diagnosed with hemophilia, an X-linked recessive disorder. His parents and newborn sister are healthy. The nurse explains how the gene for hemophilia is transmitted. Which statement by

the father indicates an understanding of X-linked recessive disorders? - ANSWER Our newborn daughter may be a carrier of the trait." The father stating that his newborn daughter may be a carrier of the trait demonstrates understanding of X-linked recessive disorders. X-linked recessive genes behave like other recessive genes. A normal dominant gene hides the effects of an abnormal recessive gene. However, the gene is expressed primarily in male offspring because it's located on the X chromosome. Male offspring of a carrier mother and an unaffected father have a 50% chance of expressing the trait whereas female offspring are more likely to carry the trait than express it. These parents may produce offspring who neither express nor carry the trait for hemophilia. A client is 37 weeks gestation and is experiencing preeclampsia. The physician has ordered magnesium sulfate, increased fetal surveillance, and increased nursing interventions. The nightshift charge nurse is preparing the patient-nurse assignment before the morning shift begins. Which of the following factors should be the primary factor in the decision surrounding who should care for this client? - ANSWER Complexity of care requirements Registered nurses are responsible for exhibiting critical thinking skills and caring for clients with fluctuating changes in their condition. This client requires extensive nursing care because she has experienced a change in health status and requires enhanced surveillance. It is critical that the nurse caring for her recognizes if her condition further deteriorates. While it is appropriate to consider senior nursing staff, client wishes and continuity of care, it is the responsibility of nurses to provide safe and ethical care. Therefore, in this context, client safety is the priority and requires that the charge nurse considers the complexity of her care requirements when assigning the appropriate care provider. A laboring client's membranes rupture, and the nurse notes that the amniotic fluid is meconium stained. Which of the following activities should the nurse immediately perform? - ANSWER Begin continuous fetal heart rate monitoring. Meconium staining in the amniotic fluid is not always a sign of fetal distress but is correlated with its occurrence. It reveals that the fetus has had an episode of loss of sphincter control. This clinical situation requires further investigation with fetal heart rate monitoring. There is no indication that birth is imminent. Changing the client to left lateral position may enhance uteroplacental exchange, allowing more oxygen to reach the fetus; however, it is most critical to assess the fetal heart rate, as this provides immediate information surrounding the health and safety of the fetus. A nurse in a psychiatric care unit finds that a client with psychosis has become violent and has struck another client in the unit. What action should the nurse take in this case? - ANSWER Restrain the client, as he is harmful to the other clients in the psychiatric care unit. Restraints should be used as a last resort and their use should be justified. Unnecessary restraining can lead to allegations of false imprisonment and battery; both are not applicable in this case, however. The nurse should inform the physician about the client, but sometimes it may not be logical to wait for orders to restrain a violent client.

Using a calm voice, the nurse should reassure that the client is safe. The nurse should not challenge the client; rather, he or she should acknowledge the hallucinatory experience. It is not appropriate to request that the client stop the behavior. Implementing restraints is not warranted at this time. Although the client is agitated, no evidence exists that the client is at risk for harming self or others. The nurse is caring for a client receiving digoxin who has begun vomiting and reports seeing colorful halos around the lights in the room. Which of the following actions should the nurse implement? Select all that apply. - ANSWER 1. D/C digoxin. 2. Begin continuous ECG monitoring for cardiac dysrhythmias. 3. Determine serum digoxin and electrolyte levels. Symptoms of digoxin toxicity include severe sinus bradycardia, colorful halos around lights, nausea, anorexia, and vomiting. A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure? Select all that apply. - ANSWER Cough Crackles Orthopnea Left-sided heart failure produces primarily pulmonary signs and symptoms, such as orthopnea, cough, and crackles. Right-sided heart failure primarily produces systemic signs and symptoms, such as ascites, jugular vein distention, and hepatomegaly. A nurse is conducting a teaching session with a group of parents on infant care and safety to assist parents in appropriately preparing to take their neonates home. Which statement about automobile restraints made by one of the parents would indicate to the nurse that learning has taken place? - ANSWER An infant should ride in a rear-facing car seat until he or she weighs 20 lb and is 1 year old." Until the infant weighs 20 lb and is 1 year old, he should ride in a rear-facing car seat. A child with hemophilia is brought to the clinic with spontaneous soft tissue bleeding of the right knee. Immediately on the child's arrival, what should the nurse do? - ANSWER Elevate the right knee. The goal is to decrease the bleeding. This can be aided by decreasing circulation to the area. Elevating the part and applying cold decreases circulation to the area. The child will also receive cryoprecipitate.