NCLEX RN Predictor Exam
Question 1 of 5.
A 79-year-old client with Alzheimer's disease is exhibiting significant memory impairment, cognitive impairment, extremely impaired judgment in social situations, and agitation when placed in a new situation or around unfamiliar people. The nurse should include the following strategy in the client's care:
A. Maintain routines and usual structure and adhere to schedules.
B. Encourage the client to attend all structured activities on the unit, whether she wants to or not.
C. Ask the client to go to an activity once. If she gives no response right away, change the question around, asking the same thing.
D. Give the client two or three choices to decide what she wants to do.
Explanation: Alzheimer's clients cope poorly with changes in routine because of memory deficits. Schedule changes cause confusion and frustration, whereas adhering to schedules is helpful and supports orientation. Insisting that the client go to all unit activities may antagonize her and increase her agitation because of cognitive impairments. It may be better to allow the client time for calming down or distraction rather than to insist that she attend every activity. When repeating a question, allow time first for a response; then use the same words the second time to avoid further confusion. The nurse should avoid giving several choices at once. Cognitively impaired clients will become more frustrated with making decisions.
Question 2 of 5.
A diagnosis of multiple sclerosis is often delayed because of the varied symptoms experienced by those affected with the disease. Which symptom is most common in those with multiple sclerosis?
A. Resting tremors
B. Double vision
C. Flaccid paralysis
D. Pill-rolling tremors
Explanation: Double vision (diplopia) is a common early symptom of multiple sclerosis due to demyelination affecting the optic nerves or brainstem.
Question 3 of 5.
A child with Down syndrome has a developmental age of four years. According to the Denver Developmental Assessment, the four-year-old should be able to:
A. Draw a man in six parts
B. Give his first and last name
C. Dress without supervision
D. Define a list of words
Explanation: Per the Denver Developmental Screening Test, a four-year-old should be able to state their first and last name, a milestone achievable despite Down syndrome delays.
Question 4 of 5.
Parents of a toddler are dismayed when they learn that their child has Duchenne's muscular dystrophy. Which statement describes the inheritance pattern of the disorder?
A. An affected gene is located on one of the 21 pairs of autosomes.
B. The disorder is caused by an over-replication of the X chromosome in males.
C. The affected gene is located on the Y chromosome of the father.
D. The affected gene is located on the X chromosome of the mother.
Explanation: Duchenne's muscular dystrophy is an X-linked recessive disorder, with the affected gene on the mother's X chromosome, primarily affecting males.
Question 5 of 5.
The physician has ordered an infusion of Osmitrol (mannitol) for a client with increased intracranial pressure. Which finding indicates the direct effectiveness of the drug?
A. Increased pulse rate
B. Increased urinary output
C. Decreased diastolic blood pressure
D. Increased pupil size
Explanation: Mannitol is an osmotic diuretic that reduces intracranial pressure by increasing urinary output, drawing fluid from the brain.
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