Cisco
CompTIA
ISC
EC-Council
EXIN
Fortinet
ITIL
Juniper
Microsoft
VMware
Avaya
SAP
Google
NVIDIA
Salesforce
Amazon
Palo Alto Networks
ISC2
Splunk
ServiceNow
All Vendors
  2. Home
  3. Exams
  4. NCLEX
  5. NCLEX-RN

NCLEX NCLEX-RN Exam
National Council Licensure Examination - NCLEX-RN (Page 28 )

Updated On: 12-Jan-2026
Page 28 of 345
PDF with 862 Questions

A 3-year-old child was hospitalized for acute laryngotracheobronchitis. During her hospitalization, the child was placed under an oxygen mist tent. The nurse's frequent monitoring of the child's temperature frightened her parents. Which response by the nurse would be most appropriate?

  1. Monitoring the temperature prevents undue chilling.
  2. Rapid temperature elevations can occur in children.
  3. Checking the temperature will prevent febrile seizures.
  4. Taking the child's temperature can prevent airway obstruction.

Answer(s): A

Explanation:

(A) The refrigerated cool mist tent creates a cool, moist environment. The child as well as bedding and clothing may become dampened. Monitoring the temperature of the child will ensure warmth and prevent chilling. (B) Only a low-grade fever is expected in laryngotracheobronchitis. (C) Febrile seizures are not expected with the low-grade fever. (D) Inflammation of the mucosal lining in the respiratory tract can cause airway obstruction. However, monitoring the child's temperature would not prevent airway obstruction.



Pin care is a part of the care plan for a client who is in skeletal traction. When assessing the site of pin insertion, which one of the following findings would the nurse know as an indicator of normal wound healing?

  1. Exudate
  2. Crust
  3. Edema
  4. Erythema

Answer(s): B

Explanation:

(A) Exudate (moist, active drainage) is a clinical sign of wound infection. (B) Crust (dry, scaly) is part of the normal stages of wound healing and should not be removed from around the pin site. It usually sloughs off after the underlying tissue has healed. (C) Edema (swelling) is a clinical sign of wound infection. (D) Erythema (redness) is a clinical sign of wound infection.



A 22-year-old client who is being seen in the clinic for a possible asthma attack stops wheezing suddenly as the nurse is doing a lung assessment. Which one of the following nursing interventions is most important?

  1. Place the client in a supine position.
  2. Draw a blood sample for arterial blood gases.
  3. Start O2 at 4 L/min.
  4. Establish a patent airway.

Answer(s): D

Explanation:

(A) During impending respiratory failure or asthmatic complications, the client is placed in the high-Fowler position to facilitate comfort and promote optimal gas exchange. (B) Arterial blood gases are monitored in the treatment of respiratory failure during an asthma attack, but it is not an initial intervention. (C) O2 therapy is used during an asthma attack, but it is not the initial intervention. The usual prescribed amount is a cautiously low flow rate of 1­2 L/min. (D) Wheezing is a characteristic clinical finding during an asthma attack. If wheezing suddenlyceases, it usually indicates a complete airway obstruction and requires immediate treatment for respiratory failure or arrest.



A behavioral modification program is recommended by the multidisciplinary team working with a 15-year-old client with anorexia nervosa. A nursing plan of care based on this modality would include:

  1. Role playing the client's eating behaviors
  2. Restriction to the unit until she has gained 2 lb
  3. Encouraging her to verbalize her feelings concerning food and food intake
  4. Provision for a high-calorie, high-protein snack between meals

Answer(s): B

Explanation:

(A) This answer is incorrect. Role playing is based on learning but is not based on the behavioral modification model. (B) This answer is correct. The behavioral modification model is based on negative and positive reinforcers to change behavior. (C) This answer is incorrect. Verbal catharsis is not an intervention based on behavioral modification. (D) This answer is incorrect. Although an acceptable nursing intervention, it is not based on behavioral modification.



A successful executive left her job and became a housewife after her marriage to a plastic surgeon. She started doing volunteer work for a charity organization. She developed pain in her legs that advanced to the point of paralysis. Her physicians can find no organic basis for the paralysis. The client's behavior can be described as:

  1. Housework phobia
  2. Malingering
  3. Conversion reaction
  4. Agoraphobia

Answer(s): C

Explanation:

(A) A typical phobia does not result in physical symptoms (i.e., paralysis). (B) Malingering is pretending to be ill. This person has a true paralysis. (C) A conversion reaction is a physical expression of an emotional conflict. It has no organic basis. (D) Agoraphobia is fear of public places.



Viewing page 28 of 345
Viewing questions 136 - 140 out of 862 questions



Post your Comments and Discuss NCLEX NCLEX-RN exam prep with other Community members:

Join the NCLEX-RN Discussion