NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
A 22-year-old client who is being seen in the clinic for a possible asthma attack stops wheezing suddenly as the nurse is doing a lung assessment. Which one of the following nursing interventions is most important?
Correct Answer: D
Rationale: During impending respiratory failure or asthmatic complications, the client is placed in the high-Fowler position to facilitate comfort and promote optimal gas exchange. Arterial blood gases are monitored in the treatment of respiratory failure during an asthma attack, but it is not an initial intervention. O2 therapy is used during an asthma attack, but it is not the initial intervention. The usual prescribed amount is a cautiously low flow rate of 1-2 L/min. Wheezing is a characteristic clinical finding during an asthma attack. If wheezing suddenly ceases, it usually indicates a complete airway obstruction and requires immediate treatment for respiratory failure or arrest.
Question 2 of 5
The nurse is performing an admission assessment on a client with a history of glaucoma. Which medication is the client most likely taking?
Correct Answer: B
Rationale: Timolol, a beta-blocker eye drop, is commonly used to reduce intraocular pressure in glaucoma. Lasix, Norvasc, and Zestril treat other conditions (edema, hypertension).
Question 3 of 5
The nurse is caring for a client with a history of a mastectomy who is receiving chemotherapy. The nurse should monitor the client for:
Correct Answer: A
Rationale: Chemotherapy commonly causes nausea and vomiting, requiring monitoring and antiemetic therapy. Hypertension, weight gain, and fever are less immediate concerns.
Question 4 of 5
A postoperative prostatectomy client is preparing for discharge from the hospital the next morning. The nurse realizes that additional instructions are necessary when he states:
Correct Answer: C
Rationale: This is correct health teaching. Drinking 10-12 glasses of clear liquid will help increase urine volumes and prevent clot formation. This is correct health teaching. These types of exercises are prescribed by physicians to assist postprostatectomy clients to strengthen their perineal muscles. This action is not recommended post-TURP because of the close proximity of the prostate and rectum. This is correct healthcare teaching. The client should limit walking long distances, lifting heavy objects, or driving a car until these activities are cleared by the physician at the first office visit.
Question 5 of 5
When the nurse checks the fundus of a client on the first postpartum day,she notes that the fundus is firm level with the umbilicus and displaced to the side. The next action the nurse should take is to:
Correct Answer: A
Rationale: A displaced fundus on the first postpartum day is often due to bladder distention which pushes the uterus aside. Checking for bladder distention (e.g. by palpation or encouraging voiding) is the next step to correct the displacement.