NCLEX-RN
RN NCLEX Practice Test Questions
Extract:
Question 1 of 5
A 32-year-old female client is being treated for Guillain-Barré syndrome. She complains of gradually increasing muscle weakness over the past several days. She has noticed an increased difficulty in ambulating and fell yesterday. When conducting a nursing assessment, which finding would indicate a need for immediate further evaluation?
Correct Answer: C
Rationale: Headaches are not associated with Guillain-Barré syndrome. Loss of superficial and deep tendon reflexes is expected with this diagnosis. Complaints of shortness of breath must be further evaluated. Forty percent of all clients have some detectable respiratory weakness and should be prepared for a possible tracheostomy. Pneumonia is also a common complication of this syndrome. Facial paralysis is expected and is not considered abnormal.
Question 2 of 5
After the RN is finished the initial assessment of a newborn baby and after the initial bonding between the newborn and the mother has taken place in the delivery room, the RN will bring the newborn to the well-baby nursery. Before the newborn is taken from the delivery room and brought to the well-baby nursery, the RN makes sure that which of the following interventions was completed?
Correct Answer: D
Rationale: Tagging the mother and infant with identical bands ensures proper identification, preventing mix-ups and ensuring safety.
Question 3 of 5
The nurse discovers that a 78-year-old client who received hydralazine (Apresoline) 20 mg 45 minutes ago has a blood pressure of 70/40 mm Hg. The client has been on this dose of the medication for 3 years. Which of the following data is most likely significant in relation to the cause of the low blood pressure?
Correct Answer: B
Rationale: (A,
D) Decreased pulse volume and increased pulse rate are signs of an acute hypotensive episode. Inadequate fluid volume when taking vasodilators can result in a drop in blood pressure when vasodilation starts to physiologically occur as an action of the drug. A potassium level of 3.3 would not be associated with a significant drop in blood pressure.
Question 4 of 5
A client is experiencing muscle weakness and lethargy. His serum K+ is 3.2. What other symptoms might he exhibit?
Correct Answer: B
Rationale: Low potassium (3.2) causes dysrhythmias due to its role in cardiac muscle activity. The other symptoms are not associated with hypokalemia.
Question 5 of 5
A client is admitted to the hospital with diabetic ketoacidosis. The emergency room nurse should anticipate the administration of:
Correct Answer: B
Rationale: Regular insulin is rapid acting and indicated in an emergency situation.