NCLEX-RN
Free NCLEX RN Exam Questions
Extract:
Question 1 of 5
A 35-year-old client has returned to her room following surgery on her right femur. She has an IV of D5 in one-half normal saline infusing at 125 mL/hr and is receiving morphine sulfate 10-15 mg IM q4h prn for pain. She last voided 5-1/2 hours ago when she was given her preoperative medication. In monitoring and promoting return of urinary function after surgery, the nurse would:
Correct Answer: C
Rationale: Provision of food and fluid promotes bowel elimination. Nutritional needs postoperatively are determined by the physician, not the client. Increasing IV fluids postoperatively will not cause a client to void. Any change in rate of administration of IV fluids should be determined by the physician. The postoperative client with normal kidney function who cannot void 8 hours after surgery is retaining urine. The client may need catheterization or medication. The physician must provide orders for both as necessary. Although morphine sulfate can cause urinary retention, withholding pain medication will not ensure that the client will void. The client with uncontrolled pain will probably not be able to void.
Question 2 of 5
On an assessment of a client's mouth, the nurse notices white patches on the buccal mucosa. The nurse tries to obtain a sample for a culture, but the lesion cannot be rubbed off. The nurse would suspect that this lesion is:
Correct Answer: C
Rationale: Leukoplakia cannot be rubbed off.
Question 3 of 5
A client has a tentative diagnosis of myasthenia gravis. The nurse recognizes that myasthenia gravis involves:
Correct Answer: B
Rationale: Myasthenia gravis is caused by autoantibodies blocking acetylcholine receptors, interrupting nerve impulse transmission to muscles, leading to weakness.
Question 4 of 5
In cleansing the perineal area around the site of catheter insertion, the nurse would:
Correct Answer: B
Rationale: Wiping away from the urinary meatus removes microorganisms from the insertion point, decreasing the risk of bladder infection. The other options increase infection risk or are inappropriate.
Question 5 of 5
Upon arrival to the nursery, Ilotycin (erythromycin) eyedrops are instilled in the newborn's eyes. The nurse understands that the medication will:
Correct Answer: B
Rationale: Erythromycin eyedrops are used prophylactically in newborns to prevent ophthalmia neonatorum, which can cause blindness.