NCLEX RN ANSWERS AND QUESTIONS SET A+
✔✔The nurse has reinforced teaching with a female client who sustained a spinal cord
injury at T5 three weeks ago. Which of the following statements by the client would
indicate a correct understanding of the teaching? Select all that apply.
1."I need to maintain a fluid intake of at least 2 L daily."
2."I will be able to ambulate with crutches once I have completed physical therapy."
3."I will need to perform range-of-motion (ROM) exercises several times each day."
4."I should see a fertility specialist if I want to conceive a child because I may be
infertile."
5."I should notify my primary health care provider if I experience a pounding headache."
- ✔✔1,3,5
✔✔The nurse is caring for a client who is receiving long-term glucocorticoid therapy.
The nurse should encourage the client to select a diet that is high in
1.calcium
2.magnesium
3.thiamine (vitamin B1)
4.vitamin K - ✔✔3.thiamine (vitamin B1)
✔✔ The nurse is contributing to the plan of care for a client with chronic obstructive
pulmonary disease (COPD). Which of the following interventions should the nurse
suggest including in the client's plan of care?
1.Place the client in low-Fowler's position for meals.
2.Provide the client with a high-carbohydrate diet and high-carbohydrate snacks.
3.Restrict the client's fluid intake to 500 mL daily.
4.Provide the client with small, frequent meals, and schedule a rest period before and
after meals. - ✔✔2.Provide the client with a high-carbohydrate diet and high-
carbohydrate snacks.
✔✔The nurse has reinforced teaching with a client who is scheduled for
electroconvulsive therapy (ECT). Which of the following statements by the client would
indicate a correct understanding of the teaching?
, 1."I will experience a tonic-clonic seizure for approximately 15 minutes during the ECT
procedure."
2."ECT is commonly used to treat depression when several antidepressants have not
been effective."
3."ECT is effective because it decreases the level of neurotransmitters in the central
nervous system."
4."Common side effects of ECT are diarrhea, a low-grade fever and short-term memory
loss." - ✔✔2. "ECT is commonly used to treat depression when several antidepressants
have not been effective."
✔✔The nurse is caring for a 6-year-old client who is receiving prescribed skeletal
traction. Which of the following would be a priority for the nurse to monitor?
1.the distance between the client's knees
2.the pull of the traction on the client's pins
3.the degree of flexion of the client's ankles
4.the position of the client's cervical spine on the bed - ✔✔2 the pull of the traction on
the client's pins
✔✔The nurse is caring for a client with dysthymic disorder. Which of the following
behaviors would the nurse expect to observe?
1.grandiose actions
2.reports of auditory hallucinations
3.expansive, pressured speech
4.inability to experience joy or pleasure in life - ✔✔4.inability to experience joy or
pleasure in life
✔✔The nurse is caring for a client. Which of the following prescriptions should the nurse
clarify? Click the exhibit button for additional client information.
1.2 g sodium diet
2.implement bed rest
3.furosemide 20 mg, p.o., once daily
4.enalapril 5 mg, p.o., twice daily - ✔✔3.furosemide 20 mg, p.o., once daily
✔✔The nurse is talking with the spouse of a client with left-sided hemiplegia. The
spouse tells the nurse, "I scheduled this appointment because I noticed a sore had
developed on my spouse's hip. I feel so guilty because I caused this to happen. I do not
know what to do." Which of the following would be an appropriate initial response for the
nurse to make?
1."Have you been offering your spouse fluids at regular time intervals?"
2."How often do you change your spouse's position?"
3."The type of care that you have undertaken is not easy."
✔✔The nurse has reinforced teaching with a female client who sustained a spinal cord
injury at T5 three weeks ago. Which of the following statements by the client would
indicate a correct understanding of the teaching? Select all that apply.
1."I need to maintain a fluid intake of at least 2 L daily."
2."I will be able to ambulate with crutches once I have completed physical therapy."
3."I will need to perform range-of-motion (ROM) exercises several times each day."
4."I should see a fertility specialist if I want to conceive a child because I may be
infertile."
5."I should notify my primary health care provider if I experience a pounding headache."
- ✔✔1,3,5
✔✔The nurse is caring for a client who is receiving long-term glucocorticoid therapy.
The nurse should encourage the client to select a diet that is high in
1.calcium
2.magnesium
3.thiamine (vitamin B1)
4.vitamin K - ✔✔3.thiamine (vitamin B1)
✔✔ The nurse is contributing to the plan of care for a client with chronic obstructive
pulmonary disease (COPD). Which of the following interventions should the nurse
suggest including in the client's plan of care?
1.Place the client in low-Fowler's position for meals.
2.Provide the client with a high-carbohydrate diet and high-carbohydrate snacks.
3.Restrict the client's fluid intake to 500 mL daily.
4.Provide the client with small, frequent meals, and schedule a rest period before and
after meals. - ✔✔2.Provide the client with a high-carbohydrate diet and high-
carbohydrate snacks.
✔✔The nurse has reinforced teaching with a client who is scheduled for
electroconvulsive therapy (ECT). Which of the following statements by the client would
indicate a correct understanding of the teaching?
, 1."I will experience a tonic-clonic seizure for approximately 15 minutes during the ECT
procedure."
2."ECT is commonly used to treat depression when several antidepressants have not
been effective."
3."ECT is effective because it decreases the level of neurotransmitters in the central
nervous system."
4."Common side effects of ECT are diarrhea, a low-grade fever and short-term memory
loss." - ✔✔2. "ECT is commonly used to treat depression when several antidepressants
have not been effective."
✔✔The nurse is caring for a 6-year-old client who is receiving prescribed skeletal
traction. Which of the following would be a priority for the nurse to monitor?
1.the distance between the client's knees
2.the pull of the traction on the client's pins
3.the degree of flexion of the client's ankles
4.the position of the client's cervical spine on the bed - ✔✔2 the pull of the traction on
the client's pins
✔✔The nurse is caring for a client with dysthymic disorder. Which of the following
behaviors would the nurse expect to observe?
1.grandiose actions
2.reports of auditory hallucinations
3.expansive, pressured speech
4.inability to experience joy or pleasure in life - ✔✔4.inability to experience joy or
pleasure in life
✔✔The nurse is caring for a client. Which of the following prescriptions should the nurse
clarify? Click the exhibit button for additional client information.
1.2 g sodium diet
2.implement bed rest
3.furosemide 20 mg, p.o., once daily
4.enalapril 5 mg, p.o., twice daily - ✔✔3.furosemide 20 mg, p.o., once daily
✔✔The nurse is talking with the spouse of a client with left-sided hemiplegia. The
spouse tells the nurse, "I scheduled this appointment because I noticed a sore had
developed on my spouse's hip. I feel so guilty because I caused this to happen. I do not
know what to do." Which of the following would be an appropriate initial response for the
nurse to make?
1."Have you been offering your spouse fluids at regular time intervals?"
2."How often do you change your spouse's position?"
3."The type of care that you have undertaken is not easy."
