the nurse is examining a patient who is reporting feeling cold which is a mechanism of heat loss in the body
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Nursing Elites

NCLEX-RN

Exam Cram NCLEX RN Practice Questions

1. The healthcare provider is examining a patient who is reporting "feeling cold."? Which is a mechanism of heat loss in the body?

Correct answer: B

Rationale: When the body needs to lose heat, one of the mechanisms it employs is radiation. Radiation involves the transfer of heat from the body to the environment in the form of infrared waves. While metabolism, exercise, and food digestion contribute to heat production, they are not mechanisms for heat loss. Metabolism generates heat as a byproduct, exercise increases metabolic rate leading to heat production, and food digestion involves some heat generation, but these processes do not directly facilitate heat loss. Therefore, in the scenario where the patient is feeling cold, radiation is the primary mechanism for the body to lose excess heat and maintain a stable internal temperature.

2. You see a sign over Mary Jones' bed when you arrive at 7 am to begin your day shift. The sign says, 'NPO'. Ms. Jones is on a regular diet. The patient asks for milk and some crackers. You _____________.

Correct answer: D

Rationale: The correct answer is that you cannot give her anything to eat or drink. 'NPO' is the standard abbreviation for 'nothing by mouth,' indicating that the patient should not consume any food or liquids. It is crucial to adhere to this restriction to prevent any potential harm or complications in the patient's condition. Choices A, B, and C are incorrect because 'NPO' clearly specifies that the patient should not have anything to eat or drink, including milk and crackers. Providing these items could lead to adverse effects, so it is essential to follow the 'NPO' directive strictly.

3. A 2-year-old child has been brought to the clinic for a well-child checkup. What is the best way for the nurse to begin the assessment?

Correct answer: C

Rationale: The best place to examine the toddler is on the parent's lap. Toddlers understand symbols; therefore, a security object is helpful. Initially, the focus is more on the parent, which allows the child to adjust gradually and to become familiar with you. A 2-year-old child does not like to take off his or her clothes. Therefore, ask the parent to undress one body part at a time.

4. To collect timely, specific information, the nurse is most likely to ask which of the following questions?

Correct answer: A

Rationale: The correct answer is, 'Would you describe what you are feeling?' This open-ended question prompts the patient to provide subjective data, offering specific information about their current health status and human responses. This information can help identify actual or potential health issues. Choices B and C are more likely to yield general, nonspecific information. Choice D may lead to a brief response or nonverbal indication of pain location. A more effective approach to gather specific information about pain would be to ask, 'Can you describe any pain you are experiencing?'

5. How does the procedure for taking a pulse rate on an infant differ from an adult?

Correct answer: B

Rationale: The correct answer is B: The apical pulse method is used on infants. This method involves placing a stethoscope in the fifth intercostal space, mid-clavicular line, and counting the beats for a full minute. It is a preferred method for infants due to their small size and the difficulty in palpating peripheral pulses accurately. Choices A, C, and D are incorrect. Choice A is incorrect as pulse rates are indeed taken on infants, albeit using a different method. Choice C is incorrect as a sphygmomanometer is typically used for measuring blood pressure, not pulse rates. Choice D is incorrect as pulse rates on infants are usually taken apically in the fifth intercostal space, not the third.

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