NCLEX-RN
NCLEX RN Practice Questions With Rationale
1. When planning care for an uninsured diabetic patient, which strategy should be a priority?
- A. Obtain less expensive medications
- B. Follow evidence-based practice guidelines
- C. Assist with dietary changes as the first action
- D. Teach about the impact of exercise on diabetes
Correct answer: B
Rationale: The priority when planning care for an uninsured diabetic patient should be to follow evidence-based practice guidelines. By adhering to standardized evidence-based guidelines, the nurse can help reduce healthcare disparities among different socioeconomic groups. While obtaining less expensive medications and assisting with dietary changes are important, the primary concern should be providing care that aligns with established standards of practice. Teaching about the impact of exercise is also valuable but may not be the priority when immediate care planning for an uninsured patient is considered.
2. Which of the following is a local sign of infection?
- A. Swelling
- B. Rapid pulse
- C. Fever
- D. High white blood count
Correct answer: A
Rationale: A local sign of infection refers to symptoms that are specific to the area of infection. Swelling, heat, pain, and redness near the infected site are examples of local signs. In the context of infection, swelling occurs due to an accumulation of fluid and immune cells at the site of infection. Rapid pulse, fever, and high white blood count are more systemic responses to infection and not specific local signs. Rapid pulse can indicate systemic distress or sepsis, fever is a systemic response to infection, and high white blood count is a laboratory finding that suggests an immune response but is not a direct sign of infection at a specific site.
3. A nurse is using active listening as a form of therapeutic communication when:
- A. She uses humor to put the client at ease in a situation
- B. She restates what the client said in slightly different words
- C. She uses eye contact and maintains an open stance while the client is talking
- D. She provides personal information to show the client she can relate to him
Correct answer: C
Rationale: Active listening is a form of therapeutic communication that involves the nurse encouraging a client to express their thoughts and feelings. Maintaining eye contact and an open stance while the client is talking demonstrates active listening and shows the client that they are being heard and understood. Using humor (Choice A) may not always be appropriate or therapeutic in all situations. Restating what the client said (Choice B) is a technique known as paraphrasing and is also a form of active listening. Providing personal information (Choice D) can shift the focus from the client to the nurse, which is not the intention of active listening.
4. Albert B. is incontinent of urine. He also wears glasses and hearing aids. His ____________lead(s) to his risk for falls.
- A. incontinence and loss of vision
- B. loss of vision
- C. incontinence
- D. loss of hearing
Correct answer: B
Rationale: Albert B. is at risk for falls due to two factors: his incontinence and his loss of vision. Loss of vision significantly impairs one's ability to navigate and avoid obstacles, thereby increasing the risk of falls. While incontinence is a risk factor for falls, the primary concern in this case is the loss of vision since it directly affects balance and safety. Therefore, the correct answer is 'loss of vision.' Choices A, C, and D are incorrect because they do not address the key factor of impaired vision leading to the risk of falls.
5. According to HIPAA, which of the following is considered an individual right for privacy of a client's protected health information?
- A. The right to receive a copy of the organization's privacy practices
- B. The right to receive medical bills for care received
- C. The right to change personal health information
- D. An understanding that protected health information will only be used in regards to client treatments
Correct answer: A
Rationale: According to HIPAA, individuals receiving care at healthcare facilities have rights surrounding their protected health information. One of these rights is to receive a copy of the organization's privacy practices, which outlines how their health information will be used and protected. This ensures transparency and allows individuals to understand how their information is handled. The other choices are incorrect because while individuals have the right to access their health information, receive explanations of how it is used, and ensure its confidentiality, receiving medical bills or changing personal health information are not specifically outlined as rights related to the privacy of protected health information.
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