NCLEX-RN
NCLEX RN Practice Questions Quizlet Questions
Extract:
Question 1 of 5
A client arrives in the emergency room after a motor vehicle accident. Witnesses tell the nurse that they observed the client's head hit the side of the car door. Nursing assessment findings include BP 70/34, heart rate 130, and respirations 22. Which is the client's most appropriate priority nursing diagnosis?
Correct Answer: B
Rationale: Hypotension (BP 70/34) and tachycardia (HR 130) indicate hypovolemic shock, likely from blood loss. Fluid volume deficit is the priority diagnosis to address life-threatening hypovolemia.
Question 2 of 5
A client is diagnosed with bleeding from the upper gastrointestinal system. The nurse would expect the client's stools to be:
Correct Answer: B
Rationale: Black, tarry stools (melena) indicate upper gastrointestinal bleeding due to digested blood.
Question 3 of 5
The nurse is caring for an 80-year-old client with Parkinson’s disease. Which of the following nursing goals is MOST realistic and appropriate in planning care for this client?
Correct Answer: B
Rationale: irreversible disease that leads to permanent physical limitations
Question 4 of 5
The nurse in a long-term care setting wants to delegate the task of ambulating an elderly client with a walker to an unlicensed assistive personnel (UAP). Before delegating a task to the UAP, the nurse should first ensure which of the following is accomplished?
Correct Answer: D
Rationale: The nurse must ensure the UAP is credentialed and trained per facility policy to perform the task safely, as this ensures competence and compliance with regulations.
Question 5 of 5
A client with inflammatory bowel disease (IBD) requires an ileostomy. The nurse would instruct the client to do which of the following measures as an essential part of caring for the stoma?
Correct Answer: D
Rationale: Meticulous cleansing of the peristomal skin prevents irritation and infection, which is critical for ileostomy care.