NCLEX-RN
NCLEX RN Practice Test Questions
Extract:
Question 1 of 5
A client arrives from surgery following an abdominal perineal resection with a permanent ileostomy. What should be the priority nursing care during the post-op period?
Correct Answer: D
Rationale: Facilitating perineal wound drainage is the priority to prevent infection and promote healing in the immediate postoperative period, as the perineal wound is at high risk for complications.
Question 2 of 5
An elderly client who experiences nighttime confusion wanders from his room into the room of another client. The nurse can best help with decreasing the client's confusion by:
Correct Answer: D
Rationale: A nightlight reduces disorientation and confusion in elderly clients by providing visual cues in the dark.
Question 3 of 5
The nurse identifies ventricular tachycardia on the heart monitor. The nurse should immediately:
Correct Answer: C
Rationale: Ventricular tachycardia requires immediate treatment with an antiarrhythmic like lidocaine to restore normal rhythm.
Question 4 of 5
A 24-year-old female client is scheduled for surgery in the morning. Which of the following is the primary responsibility of the nurse?
Correct Answer: B
Rationale: Obtaining the signed consent form is the nurse's primary responsibility to ensure informed consent before surgery.
Question 5 of 5
Following application of a right BK prosthesis for an amputated limb, the client returns for evaluation, and the nurse notes that the client has an unstable gait and the right hip and knee are showing signs of slight flexion contractures. The client admits to infrequent use of the prosthesis. Which of the following interventions are most indicated? Select all that apply.
Correct Answer: A,B,D
Rationale: Sympathetic encouragement (
A), retraining (
B), and counseling (
D) address infrequent use and contractures constructively. Chastising (
C) is non-therapeutic and demotivating.