NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
A client is pregnant for the fourth time and has had three normal vaginal deliveries. She is in active labor and fully dilated. Suddenly she calls, 'Nurse, the baby is coming.' As the nurse responds to her call, which one of the following observations should the nurse make first?
Correct Answer: A
Rationale: The nurse must assess the labor status to determine if birth is imminent. The nurse may note perineal bulging, crowning, or birth of the head to ascertain labor status. Assessing uterine contractions is one intervention to ascertain labor status. Based on the client's cry, it is not the intervention of choice. If delivery of the infant is imminent, preparing a clean or sterile area for delivery is appropriate, but labor status must be established, whether delivery is imminent, by perineal assessment. Assessing FHR is one intervention to ascertain fetal well-being. Based on the client's cry, this is not the intervention of choice.
Question 2 of 5
The nurse at a college campus is preparing to medicate several students who have been exposed to meningococcal meningitis.Which would the nurse most likely administer?
Correct Answer: B
Rationale: Ciprofloxacin is a fluoroquinolone antibiotic recommended for post-exposure prophylaxis in meningococcal meningitis due to its effectiveness against Neisseria meningitidis. Ampicillin, Vancomycin, and Piperacillin/Tazobactam are not typically used for this purpose.
Question 3 of 5
The charge nurse witnesses the nursing assistant hitting an elderly client in the long-term care facility. The nursing assistant can be charged with:
Correct Answer: C
Rationale: Hitting a client constitutes assault, a deliberate act causing harm or fear of harm. Negligence involves failure to act, tort is a broader legal term, and malpractice applies to professional errors, not intentional harm.
Question 4 of 5
The nurse reviewing the lab results of a client receiving Cytoxan (cyclophosphamide) for Hodgkin's lymphoma finds the following: WBC 4,200, RBC 3,800,000, platelets 25,000, and serum creatinine 1.0 mg. The nurse recognizes that the greatest risk for the client at this time is:
Correct Answer: B
Rationale: A platelet count of 25,000 indicates severe thrombocytopenia, posing a significant risk of bleeding, which is the greatest immediate concern compared to infection, anemia, or renal failure.
Question 5 of 5
A female client has been diagnosed with chronic renal failure. She is a candidate for either peritoneal dialysis or hemodialysis and must make a choice between the two. Which information should the nurse give her to help her decide?
Correct Answer: A
Rationale: Hemodialysis is faster in clearing the blood of toxins than peritoneal dialysis. However, clients must consider the time that they spend traveling to the dialysis center and the disruption in their daily lives. Peritoneal dialysis requires several exchanges with dwelling time for the dialysate and therefore takes longer than hemodialysis. Several serious complications of peritoneal dialysis include peritonitis, catheter displacement and/or plugging, or pain during dialysis. A client can be taught to self-administer peritoneal dialysis without the aid of a professional.