NCLEX RN Practice Questions-1

Health Promotion and Maintenance
1. During a newborn's nursing assessment, you will suspect a congenital hip dislocation if your findings include:
A. Oddly shaped feet
B. More fat folds on one thigh than the other
C. Leg appears longer on one side with less range of motion
D. Crying while kicking legs

2. An infant's PKU test is positive. The nurse's priority is to:
A. Provide PKU education to the family members
B. Change the infant's formula to Lofenlac
C. Obtain an order for packed red cells
D. Monitor vital signs every 30 minutes

3. A patient with gestational diabetes should expect:
A. To need an increase in her insulin during the third trimester of her pregnancy
B. Her dependence on insulin to be life long
C. Her newborn infant to be smaller than an infant with a non-diabetic mother
D. Her baby to require insulin as childhood diabetes will set in immediately

4. The H1N1 vaccine require that adults and children get the shot:
A. One shot each flu season
B. Adults receive one shot, children less than 10 years old receive two shots
C. Both adults and children require 2 shots one month apart
D. Children are not allowed to receive this vaccine

5. A 46 yo male patient presents to the ER with a severe headache, B/P of 190/112, and an irregular heart rate of 110. He states he did not refill his prescription for Metoprolol due to financial difficulties. His last dose was two days ago. He states that his blood pressure has never been that high before. He is probably suffering from:
A. A Myocardial Infarction
B. Cerebral hemorrhage
C. Stress
D. Rebound effect

6. An elderly patient should not:
A. Be given choices because of the stress it can cause
B. Be encouraged to let the assistant perform tasks for them
C. Be allowed visitors throughout the day; it may be too tiring
D. Be encouraged to learn new activities

Answers and Rational
1. Correct answer: B
Asymmetrical skin / fat folds on the thighs indicate a dislocated hip. This leg will appear shorter than the normal hip joint.
A – Malformed feet do not indicate hip abnormalities.
C – The side with the dislocated hip is shorter and has less range of motion. You may also notice that kicking is not of equal strength or movement.
D – Crying and kicking both legs with equal strength is normal infant behavior.

2. Correct answer: B
An infant that is positive for phenylketonuria (PKU) does not have enzymes necessary to process Phenylalanine. If this enzyme builds up in the baby it will cause mental retardation. Lofenlac is a special formula designed for infants with this condition.
A – Family education is part of the plan of care for this situation, but not the attending nurse's top priority.
C – This choice is not indicated for an abnormal PKU.
D – This choice is not indicated for an abnormal PKU.

3. Correct answer: A
The placenta releases hormones that increase cellular resistance to insulin. The amount of these hormones increase with the progression of the pregnancy, therefore the amount of insulin necessary to control blood sugar will increase.
B – Gestational diabetes usually resolves itself within a few weeks after delivery.
C – A diabetic mother most often produces a larger than normal newborn.
D – Some newborns have bouts of hypoglycemia and have to be given dextrose to keep their blood sugar within normal limits for a couple of days, but gestational diabetes does not cause childhood diabetes.

4. Correct answer: B
Adults only need one shot because of their mature immune system; kids less than 10 years old receive a second shot one month after the first.
A – The regimen differs for adults and children.
C – Adults do not require two doses.
D – Children are allowed to receive the H1N1 vaccine.

5. Correct answer: D
Suddenly stopping his Metoprolol (which lowers B/P, regulates and slows heart rate) caused a rebound effect that was worse than if he had never taken the medication at all. The rebound effect is also common with asthma medications.
A – The patient is not reporting symptoms of an MI, such as chest / arm pain and nausea.
B – There is no obvious sign or symptom of stroke such as weakness on one side, facial drooping, or slurred speech.
C – The patient is likely stressed, but that is not the primary problem.

6. Correct answer: B
The older patient must be encouraged to perform as many tasks as they can, with the assistant stepping in only when the patient is having difficulty. This maintains their level of function longer and promotes self-confidence.
A – If a patient has trouble making choices, she should be shown at least two options to pick from. For example, ask if she would prefer the blue or yellow dress today. The elderly patient should be included in the decision making process whenever possible.
C – Visitors can make a big impact on a patient's feelings of well-being, isolation, irritability, or depression. More interaction with others is generously encouraged.
D – Depending on the mental status of the patient, new activities and classes can help sharpen the mind, provide enjoyment, and increase overall quality of life.