NCLEX-RN
NCLEX RN Free Practice Questions Questions
Extract:
Question 1 of 5
A 9-year-old child was in the garage with his father, who was repairing a lawnmower. Some gasoline ignited and caused an explosion. His father was killed, and the child has split-thickness and full-thickness burns over 40% of his upper body, face, neck, and arms. All of the following nursing diagnoses are included on his care plan. Which of these nursing diagnoses should have top priority during the first 24-48 hours postburn?
Correct Answer: D
Rationale: (A, B,
C) These answers are all correct; however, maintenance of airway is the top priority. Persons burned about the face and neck during an explosion are also likely to suffer burns of the respiratory tract, which can lead to edema and respiratory arrest.
Question 2 of 5
The client with chronic renal failure is prescribed aluminum hydroxide (Amphojel). The purpose of this medication is to:
Correct Answer: A
Rationale: Aluminum hydroxide binds dietary phosphate in the gut, reducing serum phosphate levels in chronic renal failure, where kidneys cannot excrete phosphate. It does not affect urine output, ulcers, or bowel elimination directly.
Question 3 of 5
Following a vaginal delivery, the postpartum nurse should observe for:
Correct Answer: D
Rationale: Hemorrhage and infection are critical complications to monitor post-vaginal delivery due to potential uterine or perineal issues.
Question 4 of 5
A client with advanced Alzheimer’s disease has been prescribed haloperidol (Haldol). What clinical manifestation suggests that the client is experiencing side effects from this medication?
Correct Answer: B
Rationale: Haloperidol, an antipsychotic, commonly causes extrapyramidal side effects like tremors. Cough (
A), diarrhea (
C), and pitting edema (
D) are not typical side effects of haloperidol.
Question 5 of 5
A measurable outcome criterion in the nursing care of an adolescent with anorexia nervosa would be:
Correct Answer: B
Rationale: This outcome criterion is inadequate because the term 'accepts' is not directly measurable. This outcome criterion is directly measurable because specific goal-related verbalizations can be heard and verified by the nurse. 'Improved perception of body image' is not directly measurable and is therefore open to many interpretations. Although long-term goals for the anorexic client should focus on increased self-esteem, this outcome criterion (as stated) does not include specific indicators or behaviors for which to observe.