Sample NCLEX Questions l Nursing Board Exam Question Part 7

1.) The nurse is assessing a client admitted in ketoacidosis. The nurse can expect the client’s skin to be
1.Clammy
2.Flushed
3.Diaphoretic
4.Silky

Answer no. 2
Rationale:
Ketoacidosis causes dehydration that results in flushed, dry skin.

2.) The nurse is assessing a client with borderline personality disorder. It is most important for the nurse to assess for behavior indicating
1.Aggression
2.Depression
3.Sleep disturbances
4.Splitting

Answer no. 4
Rationale:
Splitting is the primitive defense mechanism seen in clients with borderline personality disorder. There is an inability to integrate both good and bad aspects of self and others into an integrated whole. This results in both an idealization and a devaluation of others and self.

3.) The nurse is caring for a client from an Asian culture. The client refuses to look at the nurse and does not maintain eye contact. The best interpretation of this behavior is that
1.The client is angry at the nurse.
2.The nurse is not effective in communicating with the client.
3.The client does not understand English.
4.The client is treating the nurse with respect.

Answer no. 4
Rationale:
In many Asian cultures a person does not look directly at a person who is in a position of authority or who is greatly respected.

4.) A one-year-old child has a staph skin infection. Her brother has also developed the same infection. Which behavior by the children is most likely to have caused the transmission of the organism?
1.Bathing together.
2.Coughing on each other.
3.Sharing pacifiers.
4.Eating off the same plate.

Answer no. 1
Rationale:
Direct contact is the mode of transmission for staphylococcus.

5.) The nurse is talking with a young woman client in the health clinic who is concerned she may have a sexually transmitted disease. The nurse commends her for seeking medical care. The nurse explains that the major reason treatment of the majority of STDs is delayed is because
1.The client is embarrassed.
2.Symptoms are thought to be caused by something else.
3.Symptoms are ignored.
4.The client never has symptoms.

Answer no. 4
Rationale:
Chlamydia is the #1 STD. Many women who harbor chlamydia in the cervix are asymptomatic. As many as 15%-50% of females and 5%-25% of males with Neisseria gonorrhoeae infection are asymptomatic carriers. In women, the primary chancre of syphilis may be on the endocervix and thus be undetected.