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NCLEX NCLEX-RN Exam Questions
National Council Licensure Examination - NCLEX-RN (Page 44 )

Updated On: 17-Feb-2026
Page 44 of 345
PDF with 862 Questions

A 6-month-old infant has developmental delays. His weight falls below the 5th percentile when plotted on a growth chart. A diagnosis of failure to thrive is made. What behaviors might indicate the possibility of maternal deprivation?

  1. Responsive to touch, wants to be held
  2. Uncomforted by touch, refuses bottle
  3. Maintains eye-to-eye contact
  4. Finicky eater, easily pacified, cuddly

Answer(s): B

Explanation:

(A) Normal infant attachment behaviors include responding to touch and wanting to be held. (B) Maternal deprivation behaviors include poor feeding, stiffening and refusal to eat, and inconsistencies in responsiveness. (C) Attachment behavior includes maintaining eye contact. (D) Maternal deprivation behaviors include displeasure with touch and physical contact.



A 6-month-old infant has developmental delays. His weight falls below the 5th percentile when plotted on a growth chart. A diagnosis of failure to thrive is made. What behaviors might indicate the possibility of maternal deprivation?

  1. Responsive to touch, wants to be held
  2. Uncomforted by touch, refuses bottle
  3. Maintains eye-to-eye contact
  4. Finicky eater, easily pacified, cuddly

Answer(s): B

Explanation:

(A) Normal infant attachment behaviors include responding to touch and wanting to be held. (B) Maternal deprivation behaviors include poor feeding, stiffening and refusal to eat, and inconsistencies in responsiveness. (C) Attachment behavior includes maintaining eye contact. (D) Maternal deprivation behaviors include displeasure with touch and physical contact.



Which one of the following is considered a reliable indicator for assessing the adequacy of fluid resuscitation in a 3-year-old child who suffered partial- and fullthickness burns to 25% of her body?

  1. Urine output
  2. Edema
  3. Hypertension
  4. Bulging fontanelle

Answer(s): A

Explanation:

(A) Urinary output is a reliable indicator of renal perfusion, which in turn indicates that fluid resuscitation is adequate. IV fluids are adjusted based on the urinary output of the child during fluid resuscitation. (B) Edema is an indication of increased capillary permeability following a burn injury. (C) Hypertension is an indicator of fluid volume excess. (D) Fontanelles close by 18 months of age.



Which one of the following is considered a reliable indicator for assessing the adequacy of fluid resuscitation in a 3-year-old child who suffered partial- and fullthickness burns to 25% of her body?

  1. Urine output
  2. Edema
  3. Hypertension
  4. Bulging fontanelle

Answer(s): A

Explanation:

(A) Urinary output is a reliable indicator of renal perfusion, which in turn indicates that fluid resuscitation is adequate. IV fluids are adjusted based on the urinary output of the child during fluid resuscitation. (B) Edema is an indication of increased capillary permeability following a burn injury. (C) Hypertension is an indicator of fluid volume excess. (D) Fontanelles close by 18 months of age.



The nurse working in a prenatal clinic needs to be alert to the cardinal signs and symptoms of PIH because:

  1. Immediate treatment of mild PIH includes the administration of a variety of medications
  2. Psychological counseling is indicated to reduce the emotional stress causing the blood pressure elevation
  3. Self-discipline is required to control caloric intake throughout the pregnancy
  4. The client may not recognize the early symptoms of PIH

Answer(s): D

Explanation:

(A) Mild PIH is not treated with medications. (B) Emotional stress is not the cause of blood pressure elevation in PIH. (C) Excessive caloric intake is not the cause of weight gain in PIH. (D) The client most frequently is not aware of the signs and symptoms in mild PIH.






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