NCLEX-RN
NCLEX RN Free Practice Questions Questions
Extract:
Question 1 of 5
A 2-year-old boy is in the hospital outpatient department for observation after falling out of his crib and hitting his head. The nurse calls the physician to report:
Correct Answer: D
Rationale: Perineal irritation needs to be addressed, but it is probably not necessary to call the physician. This fall in pulse rate remains within normal limits and is probably insignificant. It is important to monitor for continued change. This rise in pulse rate is probably not significant, but it is important to monitor for continued change. This temperature is above normal limits and needs medical investigation. It may or may not be related to the head injury.
Question 2 of 5
The nurse is preparing to administer digoxin (Lanoxin) to a client with heart failure. The client’s heart rate is 58 beats per minute. What is the nurse’s best action?
Correct Answer: B
Rationale: A heart rate of 58 bpm is below the threshold (60 bpm) for digoxin administration, as it may worsen bradycardia. Holding the dose and notifying the physician (
B) is safest. Administering (
A), reducing (
C), or delaying (
D) is inappropriate.
Question 3 of 5
The nurse assesses a postoperative mastectomy client and notes the breath sounds are diminished in both posterior bases. The nurse's action should be to:
Correct Answer: A
Rationale: Decreased or absent breath sounds are frequently indicators of postoperative atelectasis. Arterial blood gases are not indicated because there is no other information indicating impending danger. Increasing O2 rate is not indicated without additional information. Removing the dressing is not indicated without additional information.
Question 4 of 5
A 4-year-old child has Down syndrome. The community health nurse has coordinated a special preschool program. The nurse's primary goal is to:
Correct Answer: B
Rationale: The primary goal for a child with Down syndrome is to facilitate optimal growth and development through tailored interventions.
Question 5 of 5
A mother is unsure about the type of toys for her 17-month-old child. Based on knowledge of growth and development, what toy would the nurse suggest?
Correct Answer: A
Rationale: Increased locomotive skills make push-pull toys appropriate for the energetic toddler. Infants progress from reflex activity through simple repetitive behaviors to imitative behavior. Hand-eye coordination forms the foundation of other movements. At age 8 months, infants begin to have pincer grasp.
Toys that help infants develop the pincer grasp are recommended for this age group. Various large colored blocks are suggested toys for infants 6-12 months of age to help visual stimulation.