PEARSON NCLEX-RN QUESTIONS & RATIONALES EXAM | COMPLETE QUESTIONS WITH EXPERT
SOLUTION | 2026 LATEST UPDATED GET A+
1. 2. A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is the best
position for this client?
Side-lying with knees flexed
Knee-chest
High Fowler's with knees flexed
Semi-Fowler's with legs extended on the bed: Semi-Fowler's with legs extended on the bed 2. 3. A 25-year-old male is
admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?
Taking hourly blood pressures with mechanical cuff
Encouraging fluid intake of at least 200mL per hour Position in high Fowler's with knee
gatch raised
Administering Tylenol as ordered: Encouraging fluid intake of at least 200mL per hour.
It is important to keep the client in sickle cell crisis hydrated to prevent further sickl ing of the blood.
3. 4. Which of the following foods would the nurse encourage the client in sickle cell crisis to eat?
Peaches
Cottage cheese Popsicle
Lima beans: Popsicle.
Hydration is important in the client with sickle cell disease to prevent thrombus formation. Popsicles, gelatin, juice,
and pudding have high fluid content.
4. 5. A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client.
The client is complaining of severe pain in his feet and hands. The pulse oximetry is 92. Which of the following
interventions would be implemented first? Assume that there are orders for each intervention.
,Adjust the room temperature
Give a bolus of IV fluids
Start O2
Administer meperidine (Demerol) 75mg IV push: Start O2.
The most prominent clinical manifestation of sickle cell crisis is pain. However, the pulse oximetry indicates that
oxygen levels are low; thus, oxygenation takes precedence over pain relief.
5. 6. The nurse is instructing a client with iron-deficiency anemia. Which of the following meal plans would the
nurse expect the client to select?
Roast beef, gelatin salad, green beans, and peach pie
Chicken salad sandwich, coleslaw, French fries, ice cream
Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie
Pork chop, creamed potatoes, corn, and coconut cake: Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie
Egg yolks, wheat bread, carrots, raisins, and green, leafy vegetables are all high in iron, which is an important mineral
for this client. Roast beef, cabbage, and pork chops are also high in iron, but the side dishes accompanying these choices
are not
6. 7. Clients with sickle cell anemia are taught to avoid activities that cause hypoxia and hypoxemia. Which of the
following activities would the nurse recommend?
A family vacation in the Rocky Mountains
Chaperoning the local boys club on a snow-skiing trip
Traveling by airplane for business trips
A bus trip to the Museum of Natural History: A bus trip to the Museum of Natural History
A family vacation in the Rocky Mountains at high altitudes, cold temperatures, and airplane travel can cause sickling
episodes and should be avoided
,7. 8. The nurse is conducting an admission assessment of a client with vitamin B12 deficiency. Which of the
following would the nurse include in the physical assessment?
Palpate the spleen
Take the blood pressure
Examine the feet for petechiae
Examine the tongue: Examine the tongue
The tongue is smooth and beefy red in the client with vitamin B12 deficiency, so examining the tongue should be
included in the physical assessment.
8. 9. An African American female comes to the outpatient clinic. The physician suspects vitamin B12 deficiency
anemia. Because jaundice is often a clinical manifestation of this type of anemia, what body part would be the best
indicator?
Conjunctiva of the eye
Soles of the feet
Roof of the mouth
Shins: Roof of the mouth
The oral mucosa and hard palate (roof of the mouth) are the best indicators of jaundice in dark-skinned persons. The
conjunctiva can have normal deposits of fat, which give a yellowish hue; thus, answer A is incorrect. The soles of the
feet can be yellow if they are calloused, making answer B incorrect; the shins would be an area of darker pigment
9. 10. The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical
manifestations would be most indicative of the anemia? BP 146/88
Respirations 28 shallow
Weight gain of 10 pounds in 6 months
Pink complexion: Respirations 28 shallow
, When there are fewer red blood cells, there is less hemoglobin and less oxygen. Therefore, the client is often short of
breath
10. 11. The nurse is teaching the client with polycythemia vera about prevention of complications of the disease.
Which of the following statements by the client indicates a need for further teaching? "I will drink 500mL of fluid
or less each day."
"I will wear support hose when I am up."
"I will use an electric razor for shaving."
"I will eat foods low in iron.": "I will drink 500mL of fluid or less each day."
The client with polycythemia vera is at risk for thrombus formation. Hydrating the client with at least 3L of fluid per
day is important in preventing clot formation
11. 12. A 33-year-old male is being evaluated for possible acute leukemia.
Which of the following would the nurse inquire about as a part of the assessment?
The client collects stamps as a hobby.
The client recently lost his job as a postal worker.
The client had radiation for treatment of Hodgkin's disease as a teenager.
The client's brother had leukemia as a child.: The client had radiation for treatment of Hodgkin's disease as a teenager.
Radiation treatment for other types of cancer can result in leukemia. Some hobbies and occupations involving chemicals
are linked to leukemia, but not the ones in these answers; therefore, answers A and B are incorrect. Answer D is incorrect
because the incidence of leukemia is higher in twins than in siblings.
12. 13. An African American client is admitted with acute leukemia. The nurse is assessing for signs and symptoms
of bleeding. Where is the best site for examining for the presence of petechiae?
The abdomen
The thorax
The earlobes
SOLUTION | 2026 LATEST UPDATED GET A+
1. 2. A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is the best
position for this client?
Side-lying with knees flexed
Knee-chest
High Fowler's with knees flexed
Semi-Fowler's with legs extended on the bed: Semi-Fowler's with legs extended on the bed 2. 3. A 25-year-old male is
admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?
Taking hourly blood pressures with mechanical cuff
Encouraging fluid intake of at least 200mL per hour Position in high Fowler's with knee
gatch raised
Administering Tylenol as ordered: Encouraging fluid intake of at least 200mL per hour.
It is important to keep the client in sickle cell crisis hydrated to prevent further sickl ing of the blood.
3. 4. Which of the following foods would the nurse encourage the client in sickle cell crisis to eat?
Peaches
Cottage cheese Popsicle
Lima beans: Popsicle.
Hydration is important in the client with sickle cell disease to prevent thrombus formation. Popsicles, gelatin, juice,
and pudding have high fluid content.
4. 5. A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client.
The client is complaining of severe pain in his feet and hands. The pulse oximetry is 92. Which of the following
interventions would be implemented first? Assume that there are orders for each intervention.
,Adjust the room temperature
Give a bolus of IV fluids
Start O2
Administer meperidine (Demerol) 75mg IV push: Start O2.
The most prominent clinical manifestation of sickle cell crisis is pain. However, the pulse oximetry indicates that
oxygen levels are low; thus, oxygenation takes precedence over pain relief.
5. 6. The nurse is instructing a client with iron-deficiency anemia. Which of the following meal plans would the
nurse expect the client to select?
Roast beef, gelatin salad, green beans, and peach pie
Chicken salad sandwich, coleslaw, French fries, ice cream
Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie
Pork chop, creamed potatoes, corn, and coconut cake: Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie
Egg yolks, wheat bread, carrots, raisins, and green, leafy vegetables are all high in iron, which is an important mineral
for this client. Roast beef, cabbage, and pork chops are also high in iron, but the side dishes accompanying these choices
are not
6. 7. Clients with sickle cell anemia are taught to avoid activities that cause hypoxia and hypoxemia. Which of the
following activities would the nurse recommend?
A family vacation in the Rocky Mountains
Chaperoning the local boys club on a snow-skiing trip
Traveling by airplane for business trips
A bus trip to the Museum of Natural History: A bus trip to the Museum of Natural History
A family vacation in the Rocky Mountains at high altitudes, cold temperatures, and airplane travel can cause sickling
episodes and should be avoided
,7. 8. The nurse is conducting an admission assessment of a client with vitamin B12 deficiency. Which of the
following would the nurse include in the physical assessment?
Palpate the spleen
Take the blood pressure
Examine the feet for petechiae
Examine the tongue: Examine the tongue
The tongue is smooth and beefy red in the client with vitamin B12 deficiency, so examining the tongue should be
included in the physical assessment.
8. 9. An African American female comes to the outpatient clinic. The physician suspects vitamin B12 deficiency
anemia. Because jaundice is often a clinical manifestation of this type of anemia, what body part would be the best
indicator?
Conjunctiva of the eye
Soles of the feet
Roof of the mouth
Shins: Roof of the mouth
The oral mucosa and hard palate (roof of the mouth) are the best indicators of jaundice in dark-skinned persons. The
conjunctiva can have normal deposits of fat, which give a yellowish hue; thus, answer A is incorrect. The soles of the
feet can be yellow if they are calloused, making answer B incorrect; the shins would be an area of darker pigment
9. 10. The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical
manifestations would be most indicative of the anemia? BP 146/88
Respirations 28 shallow
Weight gain of 10 pounds in 6 months
Pink complexion: Respirations 28 shallow
, When there are fewer red blood cells, there is less hemoglobin and less oxygen. Therefore, the client is often short of
breath
10. 11. The nurse is teaching the client with polycythemia vera about prevention of complications of the disease.
Which of the following statements by the client indicates a need for further teaching? "I will drink 500mL of fluid
or less each day."
"I will wear support hose when I am up."
"I will use an electric razor for shaving."
"I will eat foods low in iron.": "I will drink 500mL of fluid or less each day."
The client with polycythemia vera is at risk for thrombus formation. Hydrating the client with at least 3L of fluid per
day is important in preventing clot formation
11. 12. A 33-year-old male is being evaluated for possible acute leukemia.
Which of the following would the nurse inquire about as a part of the assessment?
The client collects stamps as a hobby.
The client recently lost his job as a postal worker.
The client had radiation for treatment of Hodgkin's disease as a teenager.
The client's brother had leukemia as a child.: The client had radiation for treatment of Hodgkin's disease as a teenager.
Radiation treatment for other types of cancer can result in leukemia. Some hobbies and occupations involving chemicals
are linked to leukemia, but not the ones in these answers; therefore, answers A and B are incorrect. Answer D is incorrect
because the incidence of leukemia is higher in twins than in siblings.
12. 13. An African American client is admitted with acute leukemia. The nurse is assessing for signs and symptoms
of bleeding. Where is the best site for examining for the presence of petechiae?
The abdomen
The thorax
The earlobes
