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NCLEX Practice Exam Questions and Answers 100% Solved

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NCLEX Practice Exam Questions and Answers 100% Solved A nurse is assessing the integumentary system of four clients. Which client has the least chance of a false-positive result while undergoing assessment of capillary refill time? Client with shock Client with anemia Client with epilepsy C...

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  • October 22, 2024
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NCLEX Practice Exam Questions and

Answers 100% Solved


A nurse is assessing the integumentary system of four clients. Which client

has the least chance of a false-positive result while undergoing assessment

of capillary refill time?



Client with shock



Client with anemia



Client with epilepsy



Client with peripheral vascular disease - ✔✔C



A client with epilepsy does not have any circulatory inadequacy. Therefore

the capillary refill time of this client, as assessed in the nails, is a reliable

,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.

indicator (i.e., does not reveal a false-positive result). A client with shock

has decreased oxygen saturation levels that further prolong the capillary

refill time. Capillary refill time is not a reliable indicator of blood circulation

for clients with anemia, peripheral vascular disease, or diabetes.

While performing a physical assessment of a client, a nurse notices patchy

areas with loss of pigmentation on the skin, hands, and arms. What is the

probable etiology for this condition?



Anemia



Pregnancy



Lung disease



Autoimmune disease - ✔✔D



Patchy areas with loss of pigmentation on skin, hands, and arms are due to

vitiligo, which is caused by an autoimmune or congenital disease. Anemia

results in pallor due to a reduced amount of oxyhemoglobin. A tan-brown

,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.

color of the skin is noticed in pregnancy due to an increased amount of

melanin. Lung disease or heart failure can cause cyanosis due to an

increased amount of deoxygenated hemoglobin.



Test-Taking Tip: You have at least a 25% chance of selecting the correct

response in multiple-choice items. If you are uncertain about a question,

eliminate the choices that you believe are wrong and then call on your

knowledge, skills, and abilities to choose from the remaining responses.

While caring for a client with heat stroke, the nurse measured the

temperature and noted it as 109o F. Convert this temperature into Celsius

and record your number using one decimal place. - ✔✔42.8



Fahrenheit is converted to Celsius by subtracting 32 from the Fahrenheit

reading and multiplying the obtained value by 5/9.

C = (F - 32)(5/9)

C = (109 - 32)(5/9)

C = 42.8

The nurse is caring for a client who is on a low-carbohydrate diet. With this

diet, there is decreased glucose available for energy and fat is metabolized

, ©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.

for energy, resulting in an increased production of which substance in the

urine?



Protein



Glucose



Ketones



Uric acid - ✔✔C



As a result of fat metabolism, ketone bodies are formed, and the kidneys

attempt to decrease the excess by filtration and excretion. Excessive

ketones in the blood can cause metabolic acidosis. A low-carbohydrate diet

does not cause increased protein, glucose, or uric acid in the urine.

The nurse is caring for a client with a temperature of 104.5 degrees

Fahrenheit (40.3 degrees Celsius). The nurse applies a cooling blanket and

administers an antipyretic medication. The nurse explains that the rationale

for these interventions is to do what?

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