NCLEX-PN
NCLEX Trainer Test 6 Questions
Extract:
Question 1 of 5
A client had a thoracotomy 3 hours ago. For the past 2 hours there has been 100 cc per hour of bloody chest drainage. Which of the following actions should the nurse take FIRST?
Correct Answer: D
Rationale: Excessive chest drainage (100 cc/hour) suggests hemorrhage, requiring immediate physician notification. Options A, B, and C are secondary interventions.
Question 2 of 5
In planning care for a child diagnosed with minimal change nephrotic syndrome, the nurse should understand the relationship between edema formation and
Correct Answer: B
Rationale: Decreased colloidal osmotic pressure in the capillaries. Loss of albumin reduces osmotic pressure, causing edema.
Question 3 of 5
A child is admitted with acute glomerulonephritis. Which finding in the client's history is most consistent with the diagnosis?
Correct Answer: B
Rationale: Acute glomerulonephritis is often post-streptococcal, following pharyngitis by 1-3 weeks, due to immune complex deposition in glomeruli. Tick bites, mosquito bites, or uric acid are unrelated.
Question 4 of 5
A cooling blanket is ordered for an adult client who has a temperature of 106°F. What nursing action is essential because the client has a cooling blanket?
Correct Answer: B
Rationale: Turning every two hours prevents skin breakdown from prolonged cooling blanket contact.
Tongue blades, ice, or heavy coverings are inappropriate.
Question 5 of 5
A client with acromegaly will most likely experience which symptom?
Correct Answer: A
Rationale: Acromegaly, caused by excess growth hormone, often leads to bone pain due to bone overgrowth. Infections , fatigue , and weight loss are less specific symptoms.