NCLEX RN COMPREHENSIVE EXAM WITH NGN,
2023 VERSION WITH A+ QUALITY
1. 1. Question
1 point(s)
Category: Physiological Integrity
A client with bacterial pneumonia is admitted to the pediatric
unit. What would the nurse expect the admitting assessment to
reveal?
o A. High fever
o B. Nonproductive cough
o C. Rhinitis
o D. Vomiting and diarrhea
Incorrect
Correct Answer: A. High fever
If the child has bacterial pneumonia, a high fever is usually
present. Increased temperature (usually more than 38 C or
100.4 F) or fever with tachycardia and/or chills and sweats is a
major clinical finding. Physical findings also vary from patient to
patient and mainly depend on the severity of lung consolidation,
the type of organism, the extent of the infection, host factors,
and existence or nonexistence of pleural effusion.
• Option B: Bacterial pneumonia usually presents with
a productive cough, not a nonproductive cough. The
presence of a productive cough is the most common
and significant presenting symptom. The lower
respiratory tract is not sterile, and it always is
exposed to environmental pathogens. Invasion and
propagation of the above-mentioned bacteria into lung
parenchyma at alveolar level causes bacterial
pneumonia, and the body’s inflammatory response
against it causes the clinical syndrome of pneumonia.
• Option C: Rhinitis is often seen with viral pneumonia.
Features in the history of bacterial pneumonia may
, vary from indolent to fulminant. Clinical manifestation
includes both constitutional findings and findings due
to damage to the lung and related tissue.
• Option D: Vomiting and diarrhea are usually not seen
with pneumonia. Atypical pneumonia presents with
pulmonary and extrapulmonary manifestations, such
as Legionella pneumonia, often presents with altered
mentation and gastrointestinal symptoms.
2. 2. Question
1 point(s)
Category: Safe and Effective Care Environment
The nurse is caring for a client admitted with epiglottitis. Because
of the possibility of complete obstruction of the airway, which of
the following should the nurse have available?
o A. Intravenous access supplies
o B. A tracheostomy set
o C. Intravenous fluid administration pump
o D. Supplemental oxygen
Incorrect
Correct Answer: B. A tracheostomy set
For a child with epiglottitis and the possibility of complete
obstruction of the airway, emergency tracheostomy equipment
should always be kept at the bedside. Prepare for intubation or
tracheostomy; Anticipate the need of an artificial airway. An
artificial airway is required to promote oxygenation and
ventilation and prevent aspiration.
• Option A: Administer IV antibiotics as ordered. After
obtaining blood and epiglottic cultures, second-or-
third generation cephalosporins and beta-lactamase-
resistant antibiotics should be started as soon as
possible.
• Option C: Discourage examining throat with a tongue
blade or taking throat culture unless immediate
emergency equipment and personnel at hand. Position
the child in a sitting up and leaning forward position
with mouth open and tongue out (“tripod” position).
, Allows maximum entry of air into the lungs for
improved oxygenation.
• Option D: Oxygen will not treat an obstruction.
Endotracheal intubation must be readily available;
assist with tracheostomy if needed or prepare for the
procedure in surgery. Establishes airway if obstruction
present and respiratory failure and asphyxia are
imminent.
3. 3. Question
1 point(s)
Category: Physiological Integrity
A 25-year-old client with Grave’s disease is admitted to the unit.
What would the nurse expect the admitting assessment to
reveal?
o A. Bradycardia
o B. Decreased appetite
o C. Exophthalmos
o D. Weight gain
Incorrect
Correct Answer: C. Exophthalmos
Exophthalmos (protrusion of eyeballs) often occurs with
hyperthyroidism. Graves’ orbitopathy (ophthalmopathy) is caused
by inflammation, cellular proliferation and increased growth of
extraocular muscles and retro-orbital connective and adipose
tissues due to the actions of thyroid stimulating antibodies and
cytokines released by cytotoxic T lymphocytes (killer cells).
These cytokines and thyroid stimulating antibodies activate
periorbital fibroblasts and preadipocytes, causing synthesis of
excess hydrophilic glycosaminoglycans (GAG) and retro-orbital
fat growth.
• Option A: Physical signs of hyperthyroidism include
tachycardia, systolic hypertension with increased pulse
pressure, signs of heart failure (like edema, rales,
jugular venous distension, tachypnea), atrial
fibrillation, fine tremors, hyperkinesia, hyperreflexia,
warm and moist skin, palmar erythema and
, onycholysis, hair loss, diffuse palpable goiter with
thyroid bruit and altered mental status.
• Option B: Hyperthyroidism usually increases the
appetite. If the client is taking in a lot more calories,
they can gain weight even if their body is burning
more energy. Make sure to eat healthy foods, get
regular exercise, and work with a doctor on a nutrition
plan. These steps can all help combat weight gain
from an increased appetite.
• Option D: In younger patients, common
presentations include heat intolerance, sweating,
fatigue, weight loss, palpitation, hyper defecation, and
tremors. Other features include insomnia, anxiety,
nervousness, hyperkinesia, dyspnea, muscle
weakness, pruritus, polyuria, oligomenorrhea or
amenorrhea in the female, loss of libido, and neck
fullness.
4. 4. Question
1 point(s)
Category: Health Promotion and Maintenance
The nurse is providing dietary instructions to the mother of an 8-
year-old child diagnosed with celiac disease. Which of the
following foods, if selected by the mother, would indicate her
understanding of the dietary instructions?
o A. Ham sandwich on whole-wheat toast
o B. Spaghetti and meatballs
o C. Hamburger with ketchup
o D. Cheese omelet
Correct
Correct Answer: D. Cheese omelet
The child with celiac disease should be on a gluten-free diet.
When a child has celiac disease, gluten causes the immune
system to damage or destroy villi. Villi are the tiny, fingerlike
tubules that line the small intestine. The villi’s job is to get food
nutrients to the blood through the walls of the small intestine. If
villi are destroyed, the child may become malnourished, no
matter how much he eats. This is because they aren’t able to
2023 VERSION WITH A+ QUALITY
1. 1. Question
1 point(s)
Category: Physiological Integrity
A client with bacterial pneumonia is admitted to the pediatric
unit. What would the nurse expect the admitting assessment to
reveal?
o A. High fever
o B. Nonproductive cough
o C. Rhinitis
o D. Vomiting and diarrhea
Incorrect
Correct Answer: A. High fever
If the child has bacterial pneumonia, a high fever is usually
present. Increased temperature (usually more than 38 C or
100.4 F) or fever with tachycardia and/or chills and sweats is a
major clinical finding. Physical findings also vary from patient to
patient and mainly depend on the severity of lung consolidation,
the type of organism, the extent of the infection, host factors,
and existence or nonexistence of pleural effusion.
• Option B: Bacterial pneumonia usually presents with
a productive cough, not a nonproductive cough. The
presence of a productive cough is the most common
and significant presenting symptom. The lower
respiratory tract is not sterile, and it always is
exposed to environmental pathogens. Invasion and
propagation of the above-mentioned bacteria into lung
parenchyma at alveolar level causes bacterial
pneumonia, and the body’s inflammatory response
against it causes the clinical syndrome of pneumonia.
• Option C: Rhinitis is often seen with viral pneumonia.
Features in the history of bacterial pneumonia may
, vary from indolent to fulminant. Clinical manifestation
includes both constitutional findings and findings due
to damage to the lung and related tissue.
• Option D: Vomiting and diarrhea are usually not seen
with pneumonia. Atypical pneumonia presents with
pulmonary and extrapulmonary manifestations, such
as Legionella pneumonia, often presents with altered
mentation and gastrointestinal symptoms.
2. 2. Question
1 point(s)
Category: Safe and Effective Care Environment
The nurse is caring for a client admitted with epiglottitis. Because
of the possibility of complete obstruction of the airway, which of
the following should the nurse have available?
o A. Intravenous access supplies
o B. A tracheostomy set
o C. Intravenous fluid administration pump
o D. Supplemental oxygen
Incorrect
Correct Answer: B. A tracheostomy set
For a child with epiglottitis and the possibility of complete
obstruction of the airway, emergency tracheostomy equipment
should always be kept at the bedside. Prepare for intubation or
tracheostomy; Anticipate the need of an artificial airway. An
artificial airway is required to promote oxygenation and
ventilation and prevent aspiration.
• Option A: Administer IV antibiotics as ordered. After
obtaining blood and epiglottic cultures, second-or-
third generation cephalosporins and beta-lactamase-
resistant antibiotics should be started as soon as
possible.
• Option C: Discourage examining throat with a tongue
blade or taking throat culture unless immediate
emergency equipment and personnel at hand. Position
the child in a sitting up and leaning forward position
with mouth open and tongue out (“tripod” position).
, Allows maximum entry of air into the lungs for
improved oxygenation.
• Option D: Oxygen will not treat an obstruction.
Endotracheal intubation must be readily available;
assist with tracheostomy if needed or prepare for the
procedure in surgery. Establishes airway if obstruction
present and respiratory failure and asphyxia are
imminent.
3. 3. Question
1 point(s)
Category: Physiological Integrity
A 25-year-old client with Grave’s disease is admitted to the unit.
What would the nurse expect the admitting assessment to
reveal?
o A. Bradycardia
o B. Decreased appetite
o C. Exophthalmos
o D. Weight gain
Incorrect
Correct Answer: C. Exophthalmos
Exophthalmos (protrusion of eyeballs) often occurs with
hyperthyroidism. Graves’ orbitopathy (ophthalmopathy) is caused
by inflammation, cellular proliferation and increased growth of
extraocular muscles and retro-orbital connective and adipose
tissues due to the actions of thyroid stimulating antibodies and
cytokines released by cytotoxic T lymphocytes (killer cells).
These cytokines and thyroid stimulating antibodies activate
periorbital fibroblasts and preadipocytes, causing synthesis of
excess hydrophilic glycosaminoglycans (GAG) and retro-orbital
fat growth.
• Option A: Physical signs of hyperthyroidism include
tachycardia, systolic hypertension with increased pulse
pressure, signs of heart failure (like edema, rales,
jugular venous distension, tachypnea), atrial
fibrillation, fine tremors, hyperkinesia, hyperreflexia,
warm and moist skin, palmar erythema and
, onycholysis, hair loss, diffuse palpable goiter with
thyroid bruit and altered mental status.
• Option B: Hyperthyroidism usually increases the
appetite. If the client is taking in a lot more calories,
they can gain weight even if their body is burning
more energy. Make sure to eat healthy foods, get
regular exercise, and work with a doctor on a nutrition
plan. These steps can all help combat weight gain
from an increased appetite.
• Option D: In younger patients, common
presentations include heat intolerance, sweating,
fatigue, weight loss, palpitation, hyper defecation, and
tremors. Other features include insomnia, anxiety,
nervousness, hyperkinesia, dyspnea, muscle
weakness, pruritus, polyuria, oligomenorrhea or
amenorrhea in the female, loss of libido, and neck
fullness.
4. 4. Question
1 point(s)
Category: Health Promotion and Maintenance
The nurse is providing dietary instructions to the mother of an 8-
year-old child diagnosed with celiac disease. Which of the
following foods, if selected by the mother, would indicate her
understanding of the dietary instructions?
o A. Ham sandwich on whole-wheat toast
o B. Spaghetti and meatballs
o C. Hamburger with ketchup
o D. Cheese omelet
Correct
Correct Answer: D. Cheese omelet
The child with celiac disease should be on a gluten-free diet.
When a child has celiac disease, gluten causes the immune
system to damage or destroy villi. Villi are the tiny, fingerlike
tubules that line the small intestine. The villi’s job is to get food
nutrients to the blood through the walls of the small intestine. If
villi are destroyed, the child may become malnourished, no
matter how much he eats. This is because they aren’t able to
