NCLEX-RN
Free NCLEX RN Practice Test Questions
Extract:
Question 1 of 5
A 78-year-old client with a history of diabetes mellitus type 2, GERD, and hypertension is hospitalized with pneumonia and rings the call bell at 11 PM, complaining of being unable to sleep and having 'indigestion' and 'heartburn.' Which of the following initial interventions is most indicated?
Correct Answer: D
Rationale: In an elderly client with comorbidities, indigestion and heartburn may indicate a cardiac event, so assessing cardiac and respiratory status (
D) is the priority. Administering medications (A, B,
C) is secondary.
Question 2 of 5
The nurse is assessing a newborn in the well-baby nursery. Which finding should alert the nurse to the possibility of a cardiac anomaly?
Correct Answer: A
Rationale: Diminished femoral pulses suggest coarctation of the aorta, a cardiac anomaly, requiring further evaluation.
Question 3 of 5
The nursing assistant finds a client on the floor. Once the client is safe, which of the following should the nurse do next?
Correct Answer: B
Rationale: Falls require documentation in the medical record and an incident report to track safety issues and ensure follow-up.
Question 4 of 5
The nurse is seeing a client in the clinic who has shingles (herpes zoster). The client is concerned about spreading the disease to others. How should the nurse respond?
Correct Answer: B
Rationale: Shingles is contagious to immunocompromised individuals, such as those with leukemia, via contact with active lesions. The vaccine is recommended for older adults, not all ages, and recurrence is possible.
Question 5 of 5
An older adult has become very confused after surgery for repair of a hip fracture. The client has repeatedly tried to climb over the bedrails and the nurse is considering placing the client in a Posey vest that is secured to the bed. Which of the following must the nurse consider when applying restraints to a client? Select all that apply.
Correct Answer: A,C,D
Rationale: Alternatives (
A), reassessment every 2 hours (
C), and a written policy (
D) are required for restraints. Confused clients aren't always safer (
B), most restrictive (E) is incorrect, and an order is needed (F).