NCLEX-RN
Practice NCLEX RN Questions Questions
Extract:
Question 1 of 5
A client admitted with hepatic encephalopathy continues to attempt ambulation without assistance despite repeated instruction. Which intervention should the nurse take to promote safety?
Correct Answer: D
Rationale: Moving the client closer to the nurses’ station allows frequent monitoring, promoting safety without restraints or sedation, which are less appropriate.
Question 2 of 5
The nurse is caring for a client with dementia who tends to wander. Which of the following actions can help with this behavior? Select all that apply.
Correct Answer: A, B, C, D
Rationale: Frequent toileting, pain management, reorientation, and close monitoring address wandering causes and promote safety. Restraints are a last resort and not ideal for wandering.
Question 3 of 5
The nurse is caring for a child in a plaster-of-Paris hip spica cast. To facilitate drying, the nurse should:
Correct Answer: C
Rationale: Turning the child every 2 hours ensures even drying of the cast and prevents pressure sores, promoting comfort and healing.
Question 4 of 5
A client is being discharged with an implantable cardioverter-defibrillator (ICD), and the nurse is educating the client about home management. The client asks what he should do if the ICD fires one time but he has no other symptoms. Which of the following is the best advice?
Correct Answer: D
Rationale: A single ICD firing without symptoms should be reported to the physician (
D) for evaluation. Calling 9-1-1 (
A) or going to the ED (
B) is unnecessary, and resuming activities (
C) may be premature.
Question 5 of 5
The client has a nitroprusside drip infusing at 0.3 mcg/kg/min. The concentration is 50 mg nitroprusside in 250 mL D5W. The client weighs 70 kg. What will the IV infusion rate be?
Correct Answer: 6.3 mL/hr
Rationale:
To calculate: 0.3 mcg/kg/min × 70 kg = 21 mcg/min. Concentration is 50 mg/250 mL = 200 mcg/mL. Rate = 21 mcg/min ÷ 200 mcg/mL = 0.105 mL/min × 60 min/hr = 6.3 mL/hr.