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
A client has ataxia following a cerebral vascular accident. The nurse should:
Correct Answer: A
Rationale: Ataxia post-stroke causes unsteady gait, increasing fall risk. Supervising ambulation ensures safety. Intake/output, speech therapy, and writing aids are unrelated to ataxia.
Question 3 of 5
As the client reaches 6cm dilation,the nurse notes late decelerations on the fetal monitor. What is the most likely explanation of this pattern?
Correct Answer: D
Rationale: Late decelerations indicate uteroplacental insufficiency where reduced placental blood flow during contractions causes fetal hypoxia. Cord compression causes variable decelerations head compression causes early decelerations and sleep does not cause decelerations.
Question 4 of 5
A client has been instructed in how to take her nitroglycerin tablets. The nurse giving her instructions knows the client understands the information when she tells her:
Correct Answer: C
Rationale: Headaches may occur after taking nitroglycerin because of vasodilation. The tablets do not need to be refrigerated. The client should carry them with her. The client should contact the physician if repeated doses of nitroglycerin do not relieve the discomfort. Nitroglycerin tablets should be dissolved under the tongue, not swallowed.
Question 5 of 5
A child is to receive atropine 0.15 mg (1/400 g) as part of his preoperative medication. A vial containing atropine 0.4 mg (1/150 g)/mL is on hand. How much atropine should be given?
Correct Answer: B
Rationale: The answer is correct. 0.4 mg = 1 mL : 0.15 mg = x mL, 0.4x = 0.15, x = 0.15 / 0.4, x = 0.375 or 0.38 mL. Sufficient information is provided to determine the amount of atropine to administer. The amount of atropine available and the amount of atropine ordered is required to determine the amount of atropine to be given.