NCLEX-RN Free Practice Test

- (Topic 4)
Primary nursing diagnoses for the antisocial client are:

1. A. Alteration in perception and altered self-concept
2. B. Impaired social interaction, ineffective individual coping, and altered self-concept
3. C. Altered communication processes and altered recreational patterns
4. D. Altered body image and altered thought processes

Correct Answer: B
(A) This answer is incorrect. Perception is not altered because the client is not psychotic.
(B) This answer is correct. The antisocial client lacks responsibility, accountability, and social commitment; has impaired problem-solving ability; tends to overuse defense mechanisms; lies and steals; and is often grandiose concerning self. (C) This answer is incorrect. Altered communication processes do not characterize this client. The antisocial person communicates well and tends to have a charming personality. (D) This answer is incorrect. Altered thought processes refer to delusional thinking, which is bizarre and fixed, and do not characterize this client.

- (Topic 1)
Discharge teaching was effective if the parents of a child with atopic dermatitis could state the importance of:

1. A. Maintaining a high-humidified environment
2. B. Furry, soft stuffed animals for play
3. C. Showering 3–4 times a day
4. D. Wrapping hands in soft cotton gloves

Correct Answer: D
(A) Maintaining a low-humidified environment. (B) Avoiding furry, soft stuffed animals for play, which may increase symptoms of allergy. (C) Avoiding showering, which irritates the dermatitis, and encouraging bathing 4 times a day in colloid bath for temporary relief. (D) Wrapping hands in soft cotton gloves to prevent skin damage during scratching.

- (Topic 4)
A male client was diagnosed 6 months ago with amyotrophic lateral sclerosis (ALS). The progression of the disease has been aggressive. He is unable to maintain his personal hygiene without assistance. Ambulation is most difficult, requiring him to use a wheelchair and rely on assistance for mobility. He recently has become severely dysphasic. Nursing interventions for dysphasia would be aimed toward prevention of:

1. A. Loss of ability to speak and communicate effectively
2. B. Aspiration and weight loss
3. C. Secondary infection resulting from poor oral hygiene
4. D. Drooling

Correct Answer: B
(A) Loss of ability to speak is not dysphasia. Although the client may have difficulty communicating, alternative measures can be developed to enhance communication. This goal, while important, is of a lesser priority. (B) Dysphasia is difficulty swallowing, which could result in aspiration of food and inability to eat, causing weight loss. (C) A secondary infection could result from poor oral hygiene, which could enhance the client??s inability to eat, but this goal is of a lesser priority. (D) Drooling normally occurs in clients with amyotrophic lateral sclerosis and may require suctioning. Drooling, while aggravating for the client, does not pose an immediate danger.

- (Topic 2)
A client is in early labor. Her fetus is in a left occipitoanterior (LOA) position; fetal heart sounds are best auscultated just:

1. A. Below the umbilicus toward left side of mother??s abdomen
2. B. Below the umbilicus toward right side of mother??s abdomen
3. C. At the umbilicus
4. D. Above the umbilicus to the left side of mother??s abdomen

Correct Answer: A
(A) LOA identifies a fetus whose back is on its mother??s left side, whose head is the presenting part, and whose back is toward its mother??s anterior. It is easiest to auscultate fetal heart tones (FHTs) through the fetus??s back. (B) The identified fetus??s back is on its mother??s left side, not right side. It is easiest to auscultate FHTs through the fetus??s back.
(C) In an LOA position, the fetus??s head is presenting with the back to the left anterior side of the mother. The umbilicus is too high of a landmark for auscultating the fetus??s heart rate through its back. (D) This is the correct auscultation point for a fetus in the left sacroanterior position, where the sacrum is presenting, not LOA.

- (Topic 4)
A 27-year-old primigravida stated that she got up from the chair to fix dinner and bright red blood was running down her legs. She denies any pain previously or currently. The client is very concerned about whether her baby will be all right. Her vital signs include P 120 bpm, respirations 26 breaths/min, BP 104/58 mm Hg, temperature 98.2_F, and fetal heart rate 146 bpm. Laboratory findings revealed hemoglobin 9.0 g/dL, hematocrit 26%, and coagulation studies within normal range. On admission, the peripad she wore was noted to be half saturated with bright red blood. A medical diagnosis of placenta previa is made. The priority nursing diagnosis for this client would be:

1. A. Decreased cardiac output related to excessive bleeding
2. B. Potential for fluid volume excess related to fluid resuscitation
3. C. Anxiety related to threat to self
4. D. Alteration in parenting related to potential fetal injury

Correct Answer: A
(A) Based on the client??s history, presence of bright red vaginal bleeding, and hemoglobin value on admission, the priority nursing diagnosis would be decreased cardiac output related to excessive bleeding. (B) This nursing diagnosis is a potential problem that does not exist at the present time, and therefore is not the priority problem. (C) The client??s expressed anxiety is for her child. The fetus will remain physiologically safe if the decreased cardiac output is resolved. (D) Initial spontaneous bleeding with placenta previa is rarely life threatening to the mother or the fetus. Delivery of the fetus will be postponed until fetal maturity is achieved and survival is likely.