NCLEX RN FUNDAMENTALS NEWEST

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NCLEX RN FUNDAMENTALS NEWEST

2024 ACTUAL EXAM COMPLETE 100

QUESTIONS AND CORRECT DETAILED

ANSWERS WITH RATIONALES

(VERIFIED ANSWERS) |ALREADY

GRADED A+||BRAND NEW!!

A patient appears anxious about an upcoming procedure.Which of the following responses by the nurse will reduce this patient's anxiety?

• "Don't worry. It will be fine."
• "Read this pamphlet about the procedure and let me

know if you have questions."

• "I will turn on some music for you."
• "Would you like to talk about what's bothering you?" -

ANSWER- d. "Would you like to talk about what's bothering you?"

Rationale: Anxiety is common before medical

procedures. The patient may feel helpless, isolated, or insecure. Encouraging the patient to talk about their 1 / 4

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feelings can reduce anxiety and helps the nurse be supportive by developing goals with the patient for some sense of control. This is the response that displays therapeutic communication.

A patient is admitted to the cardiac unit after myocardial infarction (MI). The patient tells the nurse they don't want their spouse to know what happened. What is the best response by the nurse?

• "I have to tell your spouse what happened."
• "I will need you to fill out paperwork preventing

anyone from telling your spouse."

• "Why don't you want me to tell your spouse?"
• "Is there someone else you would like listed as an

appropriate person with whom we can discuss your care?"

• ANSWER- d. "Is there someone else you would like

listed as an appropriate person with whom we can discuss your care?"

Rationale: Patients have the right to decide what

information regarding their condition is shared with whom. It is the responsibility of the nurse to obtain this information from the patient and document it in 2 / 4

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the medical record so others following in care will know as well. Clarifying the patient statement and determining who the patient wants involved is the best response.

The nurse is caring for a 72-year-old patient who has a history of a left-sided stroke. The patient uses a cane while walking. Which is the best way for the nurse to assess the strength of their lower extremities?

• Have the patient push with their feet against the nurse's

hands

• Observe the patient walking in the hall
• Notify the physical therapy department and request an

assessment

• Assist the patient to the bathroom - ANSWER- d.

Assist the patient to the bathroom

Rationale: Patients who have experienced a stroke

often have residual weakness on the affected side and use assistive devices to help with mobility. Using the cane and assisting the patient to the bathroom is the best way for the nurse to assess the patient's lower extremity strength. The nurse can assist the patient to 3 / 4

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the bathroom, and therefore, eliminate the risk for a fall.A is incorrect because testing pedal strength only provides assessment data about the lower legs, not the full lower extremities. B is incorrect because observing the patient walking in the hall does not give an accurate assessment of lower extremity strength and could put the patient at risk for a fall.

A patient has a urinary catheter ordered due to urinary retention. The patient should be placed in the dorsal recumbent position for the catheter insertion, but the patient states they have back pain and cannot assume that position. What is the most appropriate action the nurse should take?

• Place the patient in the dorsal recumbent position
• Place the patient on their side
• Place the patient in a prone position
• Notify the healthcare provider for an alternate order -

ANSWER- b. Place the patient on their side

Rationale: Sterile procedure is critical when placing a

urinary catheter. If the patient is unable to lie in the

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