NCLEX-RN
Exam Cram NCLEX RN Practice Questions
1. The nurse is assessing children in a pediatric clinic. Which statement is true regarding the measurement of blood pressure in children?
- A. Blood pressure guidelines for children are based on age.
- B. Phase II Korotkoff sounds are the best indicator of systolic blood pressure in children.
- C. Using a Doppler device is recommended for accurate blood pressure measurements until adolescence.
- D. The disappearance of phase V Korotkoff sounds can be used for the diastolic reading in children.
Correct answer: D
Rationale: The disappearance of phase V Korotkoff sounds can be used for the diastolic reading in children, as well as in adults. Blood pressure guidelines for children are based on more than just age, but also sex and height. Phase I Korotkoff, not Phase II, is the best indicator of systolic blood pressure. The true statement regarding the measurement of blood pressure in children is that the disappearance of phase V Korotkoff sounds can be used for the diastolic reading in children, as well as in adults.
2. Surgical asepsis is being performed when:
- A. wiping down exam tables with bleach
- B. sterilizing instruments
- C. changing table paper
- D. wearing gloves when performing injections
Correct answer: B
Rationale: Surgical asepsis refers to the process of maintaining a sterile environment to prevent the introduction of pathogens to a patient's body. Sterilizing instruments is a crucial aspect of surgical asepsis as it ensures that the instruments used during procedures are free from microorganisms that could cause infections. Wiping down exam tables with bleach may help in cleaning and disinfecting surfaces but does not pertain directly to maintaining a sterile field. Changing table paper is important for cleanliness and infection control but is not specifically related to surgical asepsis. Wearing gloves when performing injections is important for standard precautions and preventing the spread of infection but does not encompass the concept of surgical asepsis, which focuses on maintaining a sterile field during invasive procedures.
3. When evaluating the temperature of older adults, what aspect should the healthcare provider remember about an older adult's body temperature?
- A. The body temperature of the older adult is lower than that of a younger adult.
- B. An older adult's body temperature is approximately the same as that of a young child.
- C. Body temperature varies based on the type of thermometer used.
- D. In older adults, body temperature can fluctuate widely due to less effective heat control mechanisms.
Correct answer: A
Rationale: When evaluating the temperature of older adults, it is important to note that their body temperature is usually lower than that of younger adults, with a mean temperature of 36.2�C. Choice B is incorrect because an older adult's body temperature is not approximately the same as that of a young child. Choice C is incorrect because body temperature is a physiological parameter and does not vary based on the type of thermometer used. Choice D is incorrect because while older adults may have less effective heat control mechanisms, their body temperature is typically lower, not widely fluctuating.
4. The Sinoatrial Node (SA) is located within which of the following heart structures?
- A. Mitral Valve
- B. Right Ventricle
- C. Right Atrium
- D. Left Atrium
Correct answer: C
Rationale: The Sinoatrial (SA) Node, often called the heart's natural pacemaker, is situated within the upper wall of the Right Atrium. It initiates the electrical impulses that regulate the heartbeat. Choices A, B, and D are incorrect because the SA node is not located in the Mitral Valve, Right Ventricle, or Left Atrium. It is specifically positioned in the Right Atrium to coordinate the heart's rhythm and timing.
5. A patient is having difficulty understanding how to properly run her glucose meter. Which of the following teaching methods would best help the patient understand how to use her instrument correctly?
- A. Give the patient an instruction booklet and encourage her to call the office if she has questions.
- B. Tell the patient to ask a healthcare provider to demonstrate how to use the instrument.
- C. Have the patient watch a video demonstrating the use of the instrument.
- D. Demonstrate the proper use of the instrument and then have the patient perform the process while still in the office.
Correct answer: D
Rationale: By using a demonstration and performance method of patient education, the patient is offered a chance to perform a task and have learning assessed while still in the office. This ensures that any questions that the patient has can be answered immediately, and any performance issues observed by the medical assistant can also be corrected promptly. Choice A is not as effective as providing a demonstration in person, as it may not address the patient's specific learning needs or allow for immediate feedback. Choice B suggests asking a healthcare provider to demonstrate, which is similar to the correct answer but may not always be readily available in the office. Choice C, watching a video, lacks the interactive component and immediate feedback that a live demonstration provides, making it less effective in this scenario.
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