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NCLEX National Council Licensure Examination(NCLEX-RN) Sample Questions (Q144-Q149):

NEW QUESTION # 144
A hyperactive client is experiencing flight of ideas. The most therapeutic activity for him would be:

* A. Playing bridge with three other clients
* B. Playing basketball in the gym
* C. Doing crafts in occupational therapy
* D. Working a 1000-piece puzzle
Answer: B

Explanation:
Explanation/Reference:
Explanation:
(A) This activity requires motor skills and therefore would be difficult for a hyperactive client. ( emoticon

This activity would take too long, and the client would have difficulty concentrating owing to a limited attention span. (C) This client would not be able to concentrate enough to play card games. He would respond to all the stimuli in the area, become distracted, and leave the table. (D) This activity would allow the client to channel his energy in a positive way.

NEW QUESTION # 145
The most important reason to closely assess circumferential burns at least every hour is that they may result in:

* A. Hypovolemia
* B. Renal damage
* C. Loss of peripheral pulses
* D. Ventricular arrhythmias
Answer: C

Explanation:
Explanation
(A) Hypovolemia could be a result of fluid loss from thermal injury, but not as a result of the circumferential injury. ( emoticon

Renal damage is typically seen because of prolonged hypovolemia or myoglobinuria. (C) Electrical injuries and electrolyte changes typically cause arrhythmias in the burn client. (D) Full-thickness circumferential burns are nonelastic and result in an internal tourniquet effect that compromises distal blood flow when the area involved is an extremity.Circumferential full-thickness torso burns compromise respiratory motion and, when extreme, cardiac return.

NEW QUESTION # 146
A 27-year-old healthy primigravida is brought to the labor and birthing room by her husband at 32 weeks' gestation. She experienced a sudden onset of painless vaginal bleeding. Following an ultrasound examination, the diagnosis of bleeding secondary to complete placenta previa is made. Expected assessment findings concerning the abdomen would include:

* A. A rigid, boardlike abdomen
* B. Uterine atony
* C. Hypertonicity of the uterus
* D. A soft relaxed abdomen
Answer: D

Explanation:
Explanation
(A) A rigid, boardlike abdomen is an assessment finding indicative of placenta abruptio. ( emoticon

A cause of postbirth hemorrhage is uterine atony. With placenta previa, uterine tone is within normal range. (C) The placenta is located directly over the cervical os in complete previa. Blood will escape through the os, resulting in the uterus and abdomen remaining soft and relaxed. (D) In placenta abruptio, hypertonicity of the uterus is caused by the entrapment of blood between the placenta and uterine wall, a retroplacental bleed. This does not exist in placenta previa.

NEW QUESTION # 147
Following the delivery of a healthy newborn, a client has developed thrombophlebitis and is receiving heparin IV. What are the signs and symptoms of a heparin overdose for which the nurse would need to observe during postpartum care of the client?

* A. Hematuria, ecchymosis, and epistaxis
* B. Epistaxis, hematuria, dysuria
* C. Dysuria
* D. Vertigo, hematuria, ecchymosis
Answer: A

Explanation:
Section: Questions Set D
Explanation:
(A) Dysuria is not a common symptom of heparin overdose. ( emoticon

Although epistaxis and hematuria are common symptoms of heparin overdose, dysuria is not. (C) Vertigo is not a common symptom of heparin overdose. (D) Hematuria, ecchymosis, and epistaxis are the most common signs and symptoms of a heparin overdose.
Others are thrombocytopenia, elevated liver enzymes, and local injection site complications.

NEW QUESTION # 148
The nurse is notified that a 27-year-old primigravida diagnosed with complete placenta previa is to be admitted to the hospital for a cesarean section. The client is now at 36 weeks' gestation and is presently having bright red bleeding of moderate amount. On admission, the nursing intervention that the nurse should give the highest priority to is:

* A. Start an IV infusion in the client's arm
* B. Shave the client's abdomen and arrange her lab work
* C. Determine the status of the fetus by fetal heart tones
* D. Insert an indwelling catheter into her bladder
Answer: C

Explanation:
Explanation
(A) These nursing actions are necessary prior to the cesarean section, but not immediately necessary to maintain physiological equilibrium. ( emoticon

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