NCLEX-RN
NCLEX RN Practice Questions
Extract:
Question 1 of 5
A client being treated with sodium warfarin has an INR of 8.0. Which intervention would be most important to include in the nursing care plan?
Correct Answer: A
Rationale: An INR of 8.0 indicates a high risk of bleeding, so assessing for abnormal bleeding is the priority intervention.
Question 2 of 5
During the initial interview, the client reports that she has a lesion on the perineum. Further investigation reveals a small blister on the vulva that is painful to touch. The nurse is aware that the most likely source of the lesion is:
Correct Answer: B
Rationale: A painful blister on the vulva is most consistent with genital herpes, caused by the herpes simplex virus.
Question 3 of 5
The client with an abdominal aortic aneurysm is admitted in preparation for surgery. Which of the following should be reported to the doctor?
Correct Answer: A
Rationale: An elevated white blood cell count may indicate infection or inflammation, which requires prompt reporting before surgery.
Question 4 of 5
The nurse is caring for a client with stage III Alzheimer's disease. A characteristic of this stage is:
Correct Answer: D
Rationale: Stage III Alzheimer's is characterized by severe cognitive decline, including inability to communicate effectively, often limited to simple phrases or gestures.
Question 5 of 5
A client in the recovery ICU is on mechanical ventilation. The nurse notices the client has frothy secretions around his mouth, and the nurse hears adventitious breath sounds with the stethoscope. The nurse should
Correct Answer: B
Rationale: Frothy secretions and adventitious sounds suggest airway obstruction or pulmonary edema. Suctioning clears the endotracheal tube, improving ventilation.