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NCLEX NCLEX-RN Exam
National Council Licensure Examination - NCLEX-RN (Page 9 )

Updated On: 12-Jan-2026
Page 9 of 345
PDF with 862 Questions

A 22-year-old client presents with a diagnosis of antisocial personality disorder and a history of using drugs, writing numerous checks with insufficient funds, and stealing. He appears charming and intelligent, and the other clients are impressed and want to be liked by him. The greatest problem that may arise from this situation is that:

  1. He will manipulate the other clients for his own benefit
  2. He will cause the other clients to become psychotic
  3. He will become delusional and hallucinate as a result of the excess attention given to him by peers
  4. He may exhibit self-mutilative behavior

Answer(s): A

Explanation:

(A) This answer is correct. Persons with antisocial personality disorder typically are very manipulative. (B) This answer is incorrect. The client's behavior cannot cause another person to become psychotic. (C) This answer is incorrect. Psychosis is not a symptom of antisocial personality. One of the criteria for diagnosis of this disorder is that no psychosis be present. In addition, the client would love the attention. (D) This answer is incorrect. Self-mutilative behavior is characteristic of the borderline personality disorder.



A 22-year-old single woman was admitted to the psychiatric hospital by her mother, who reported bizarre behavior. Except for going to work, she spends all her time in her room and expresses concern over neighbors spying on her. She has fears of the telephone being "bugged." Her diagnosis is schizophrenia. One nurse per shift is assigned to work with the client. The primary reason for this plan would be to:

  1. Protect her from suicide
  2. Enable her to develop trust
  3. Supervise her medication regimen
  4. Involve her in groups for social interaction

Answer(s): B

Explanation:

(A) Suicide is a greater risk in depression than in schizophrenia. (B) The client is suspicious and needs help to develop trust, which is basic to her improvement. (C) Although she will be taking medication, drug therapy would not necessitate consistency in the nurses assigned. (D) A suspicious client should have limited exposure to groups, because group participation increases discomfort.



A client has received preoperative teaching for the vertical partial laryngectomy that he is scheduled to have in the morning. The nurse determines that the teaching has been effective when the client states:

  1. "I know I will need special swallowing training after my surgery."
  2. "The quality of my voice will be excellent after surgery."
  3. "I will have very little difficulty swallowing after surgery."
  4. "I may also have to have a radical neck dissection done."

Answer(s): C

Explanation:

(A) A client with a supraglottic (horizontal partial) laryngectomy would require special swallowing training, not a vertical partial laryngectomy. (B) The quality of the client's voice will be altered but adequate for communication. (C) The client will have minimal difficulty swallowing. (D) A radical neck dissection may be done with a total laryngectomy, but not with a partial laryngectomy.



A hyperactive client is experiencing flight of ideas. The most therapeutic activity for him would be:

  1. Doing crafts in occupational therapy
  2. Working a 1000-piece puzzle
  3. Playing bridge with three other clients
  4. Playing basketball in the gym

Answer(s): D

Explanation:

(A) This activity requires motor skills and therefore would be difficult for a hyperactive client. (B) This activity would take too long, and the client would have difficulty concentrating owing to a limited attention span. (C) This client would not be able to concentrate enough to play card games. He would respond to all the stimuli in the area, become distracted, and leave the table. (D) This activity would allow the client to channel his energy in a positive way.



A client sustained second- and third-degree burns to his face, neck, and upper chest. Which of the following nursing diagnoses would be given the highest priority in the first 8 hours' postburn?

  1. Fluid volume deficit secondary to alteration in skin integrity
  2. Alteration in comfort secondary to alteration in skin integrity
  3. Alteration in sensation secondary to third-degree burn
  4. Alteration in airway integrity secondary to edema of neck and face, which in turn is secondary to alteration in skin integrity

Answer(s): D

Explanation:

(A) Fluid deficit is a high priority not only during the first 8 hours postburn, but also during the first 36 hours postburn. (B) Alteration in comfort is a high priority during the entire length of the client's hospitalization and on discharge. (C) Alteration in sensation is a high priority during the first 48­72 hours postburn. Lack of sensation may be indicative of lack of circulation. (D) Alteration in airway integrity is the highest priority for this client in the first 8 hours postburn. Failure to continually assess this client's airway status could result in
poor ventilation and oxygenation, in addition to an inability to intubate the client secondary to excessive edema formation in the neck.



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