NCLEX-RN Practice Test 11 — Questions and Answers

Question 1: A toddler is 26 months old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the toddler in?

Trust vs. mistrust
Initiative vs. guilt
Autonomy vs. shame and doubt (Correct answer)
Intimacy vs. isolation

Correct answer: Autonomy vs. shame and doubt

According to Erik Erikson's stages of psychosocial development, toddlers (typically ages 1-3 years) are in the 'Autonomy vs. Shame and Doubt' stage. During this period, children strive for independence and self-control, learning to do things for themselves. Successful navigation leads to autonomy, while excessive criticism or control can lead to shame and doubt.

Question 2: A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute?

Vomiting
Extreme Thirst
Weight gain (Correct answer)
Acetone breath smell

Correct answer: Weight gain

Ketoacidosis, particularly diabetic ketoacidosis (DKA), is a serious complication characterized by high blood sugar, dehydration, and the production of ketones. Patients experiencing acute ketoacidosis typically present with symptoms like extreme thirst, frequent urination, nausea, vomiting, and a characteristic fruity (acetone) breath. Due to fluid loss and metabolic derangements, weight loss, not weight gain, is usually observed.

Question 3: A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present?

Slow pulse rate
Weight gain (Correct answer)
Decreased systolic pressure
Irregular WBC lab values

Correct answer: Weight gain

Infants with congenital heart defects often experience fluid retention due to impaired cardiac function and heart failure. This fluid buildup, or edema, can manifest as an increase in body weight, even if the infant is not growing adequately in terms of length or healthy tissue. Therefore, monitoring for sudden weight gain can be an important indicator of worsening heart failure in these patients.

Question 4: A 5-year-old child and has been recently admitted to the hospital. According to Erik Erikson's psychosocial development stages, the child is in which stage?

Trust vs. mistrust
Initiative vs. guilt (Correct answer)
Autonomy vs. shame and doubt
Intimacy vs. isolation

Correct answer: Initiative vs. guilt

A 5-year-old child falls into Erik Erikson's 'Initiative vs. Guilt' stage, which typically spans ages 3-5 years. During this stage, children begin to assert control over their world through directing play and other social interactions. They develop a sense of purpose and initiative, but if their efforts are criticized or controlled too much, they may develop guilt.

Question 5: A nurse has just started her rounds delivering medication. A new patient on her rounds is a 4-year-old boy who is non-verbal. This child does not have on any identification. What should the nurse do?

Contact the provider
Ask the child to write their name on paper
Ask a coworker about the identification of the child
Ask the father who is in the room the child’s name (Correct answer)

Correct answer: Ask the father who is in the room the child’s name

The most appropriate action for patient identification, especially for a non-verbal child without an ID band, is to ask a reliable source present. The father, being in the room, is the most immediate and reliable source to confirm the child's identity. This adheres to patient safety protocols by ensuring the correct patient receives medication, even in the absence of an ID band.

Question 6: A mother has recently been informed that her child has Down’s syndrome. You will be assigned to care for the child at shift change. Which of the following characteristics is not associated with Down’s syndrome?

Simian crease
Brachycephaly
Hypotonicity
Oily Skin (Correct answer)

Correct answer: Oily Skin

Down's syndrome (Trisomy 21) is associated with several distinct physical characteristics, including a single palmar crease (Simian crease), a flattened back of the head (Brachycephaly), and decreased muscle tone (Hypotonicity). Oily skin is not a characteristic typically associated with Down's syndrome; rather, individuals may experience dry skin or other dermatological issues.

Question 7: A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the following would be the best instruction for this patient?

Deep breathing techniques to increase oxygen levels
Cough regularly and deeply to clear airway passages
Cough following bronchodilator utilization (Correct answer)
Decrease CO2 levels by increase oxygen take output during meals

Correct answer: Cough following bronchodilator utilization

For a patient with severe COPD, effective airway clearance is crucial. Bronchodilators help to open up the airways, making it easier to move mucus. Instructing the patient to cough *after* using a bronchodilator ensures that the airways are maximally dilated, allowing for a more effective and less strenuous cough to clear secretions, optimizing respiratory function.

Question 8: A nurse is putting together a presentation on meningitis. Which of the following microorganisms has not been linked to meningitis in humans?

S. pneumonia
H. influenza
N. meningitis
Cl. difficile (Correct answer)

Correct answer: Cl. difficile

Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis are three of the most common bacterial causes of meningitis, a serious inflammation of the membranes surrounding the brain and spinal cord. Clostridium difficile, however, is a bacterium primarily known for causing severe diarrhea and colitis, particularly after antibiotic use, and is not a typical cause of meningitis.

Question 9: A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration?

Sulfasalazine
Levodopa
Phenolphthalein
Aspirin (Correct answer)

Correct answer: Aspirin

Sulfasalazine can cause orange-yellow urine, levodopa can cause dark urine (red-brown or black) upon standing, and phenolphthalein (formerly in laxatives) can cause red-pink urine in alkaline conditions. Aspirin, a common NSAID, does not typically cause urine discoloration. Its primary effects are pain relief, anti-inflammatory action, and antiplatelet aggregation, without affecting urine color.

Question 10: A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration?

Sulfasalazine
Levodopa
Phenolphthalein
Aspirin (Correct answer)

Correct answer: Aspirin

Question 11: The LPN/LVN is gathering information from the mother of a six year old girl who is at the clinic for a well-child visit. The nurse asks if the mother has any special concerns regarding her daughter. The mother states that her daughter has recently been complaining of an itchy scalp and she would like to talk with the doctor about some dandruff treatment. What would be the MOST appropriate response?

Instruct the child to never share combs, brushes or hats with her friends.
Tell the mother that her child probably has head lice and inform her of the appropriate treatment.
Inform the mother of the proper way to treat dandruff and the most effective dandruff shampoos.
Examine the child’s scalp and hair for evidence of small, white, sesame seed size flecks which cannot be brushed away or pulled off of the hair. (Correct answer)

Correct answer: Examine the child’s scalp and hair for evidence of small, white, sesame seed size flecks which cannot be brushed away or pulled off of the hair.

Given the child's age and complaint of an itchy scalp, head lice is a strong possibility, especially since dandruff is less common in young children. The most appropriate initial nursing action is to physically assess the child's scalp for nits (lice eggs), which are small, white, and firmly attached to the hair shaft, unlike dandruff flakes that can be easily brushed away. This assessment will help differentiate between dandruff and lice before suggesting treatment.

Question 12: A medical care team consists of three RN’s, and a LPN/LVN. Identify the MOST appropriate assignment for the LPN/LVN.

A multiparous OB patient who is to be discharged home along with her healthy newborn.
A multiparous repeat C-section patient who is two days post-op and breastfeeding her newborn infant. (Correct answer)
A primiparous OB patient who experienced an uneventful vaginal delivery four hours earlier.
A primiparous OB patient who had an uneventful delivery 24 hours ago, who would like to discuss tubal ligation with her nurse.

Correct answer: A multiparous repeat C-section patient who is two days post-op and breastfeeding her newborn infant.

LPNs/LVNs are typically assigned stable patients with predictable outcomes and routine care needs. A multiparous patient two days post-op from a repeat C-section, who is breastfeeding, represents a relatively stable patient with established care needs that fall within the LPN/LVN scope of practice. The other options involve patients who are either newly post-delivery, require complex discharge planning, or in-depth discussion on sensitive topics, which are more appropriate for an RN's assessment and teaching responsibilities.

Question 13: A LPN/LVN has received an assignment of four patients on the Medical-Surgical floor. Which patient should she/he go to check on first?

A 72 year old male patient with emphysema and a history of uncontrolled hypertension, who is complaining of a headache.
A 61 year old male patient who is one day post-op from hernia repair with complaints of pain at the incision site.
A 68 year old female patient with Type II Diabetes, who is complaining of stomach discomfort.
A 70 year old female patient who is two days post-op from ankle surgery who complains of feeling some shortness of breath. (Correct answer)

Correct answer: A 70 year old female patient who is two days post-op from ankle surgery who complains of feeling some shortness of breath.

The patient complaining of shortness of breath (SOB) should be seen first, as this indicates a potential respiratory issue, which falls under the 'Airway, Breathing, Circulation' (ABC) priority framework. Shortness of breath can quickly escalate into a life-threatening emergency, making it the most urgent concern among the given options. The other complaints (headache, incision pain, stomach discomfort) are less immediately life-threatening.

Question 14: A nurse is planning to reinforce instructions regarding nutrition to a Muslim patient. The nurse should be aware that certain foods are prohibited by this religion. Identify the food which is prohibited.

meat
pork (Correct answer)
spicy foods
beef and veal

Correct answer: pork

In Islam, dietary laws (Halal) prohibit the consumption of certain foods, with pork being the most prominent and universally forbidden. Muslims are also prohibited from consuming alcohol and meat from animals not slaughtered according to Islamic rites. Understanding these restrictions is crucial for providing culturally sensitive and appropriate care to Muslim patients.

Question 15: A nurse is checking the circulation in the right leg of an Asian American patient who had a total knee replacement two days ago. The patient does not smile, make eye contact and does not speak much. The nurse should:

Keep talking to the patient to try to “engage” him in conversation.
Be aware that in Asian American people, silence is valued and eye contact may be considered inappropriate. (Correct answer)
Check the patient’s chart for a history of depression.
Take the patient’s vital signs to determine if he is stable.

Correct answer: Be aware that in Asian American people, silence is valued and eye contact may be considered inappropriate.

In many Asian American cultures, direct eye contact can be considered a sign of disrespect or aggression, especially towards authority figures, and silence is often valued as a sign of respect or thoughtfulness. Therefore, the nurse should recognize these cultural norms and avoid misinterpreting the patient's behavior as disengagement or lack of understanding. Respecting these cultural differences is crucial for effective and culturally sensitive nursing care.

Question 16: A LPN/LVN is attempting to review and reinforce an African American patient’s Synthroid medication schedule. The patient nods her head up and down throughout the review of instructions. The nurse should understand that:

People of the African American culture often nod their heads “yes” even though they may not agree or understand. (Correct answer)
People of the African American culture do not believe in taking a lot of medication.
People of the African American culture do not like to ask questions.
Head nodding and disorientation are side effects of hypothyroidism.

Correct answer: People of the African American culture often nod their heads “yes” even though they may not agree or understand.

In some African American cultural contexts, head nodding may be a sign of politeness or active listening, indicating respect for the speaker, rather than necessarily signifying agreement or full comprehension. The nurse should be aware of this communication style to avoid assuming understanding. To ensure the patient truly grasps the medication schedule, the nurse should use teach-back methods or ask open-ended questions to confirm their understanding.

NCLEX-RN Practice Test 11

A toddler is 26 months old and has been recently admitted to the hospital.
According to Erikson, which of the following stages is the toddler in?