NCLEX-RN
NCLEX RN Nursing Exam Questions
Extract:
Question 1 of 5
A client is to have a coronary artery bypass graft performed in the morning using a saphenous vein. He wants to know why the physician does not use the internal mammary artery for his bypass graft because his friend's physician uses this artery. The nurse tells the client that the internal mammary artery:
Correct Answer: A
Rationale: It does take more time to remove the internal mammary artery, and this is one reason why some physicians do not use it.
Question 2 of 5
The physician has ordered 50 mEq of potassium chloride for a client with a potassium level of 2.5 mEq/L. The nurse should administer the medication:
Correct Answer: C
Rationale: Potassium chloride for hypokalemia (2.5 mEq/L) should be administered via controlled IV infusion over several hours (e.g., five hours) to prevent rapid shifts that could cause arrhythmias.
Question 3 of 5
Which nursing interventions are included in the post-operative care of the client following the repair of a retinal detachment with instillation of silicone oil?
Correct Answer: A, D, E
Rationale: Post-retinal detachment with silicone oil requires prone positioning (
A) to keep oil against the retina, head bowed when upright (
D) to maintain oil placement, and an eye patch (E) to reduce light exposure. Bed rest (
B) is not strict, and diet (
C) progresses as tolerated.
Question 4 of 5
The client is admitted with left-sided congestive heart failure. In assessing the client for edema, the nurse should check the:
Correct Answer: D
Rationale: In left-sided congestive heart failure, fluid backs up into the lungs, but dependent edema is assessed in the sacrum in bedridden clients or feet in ambulatory clients. The sacrum is the most appropriate site for hospitalized clients, as they are often recumbent.
Question 5 of 5
A client tells the nurse that she takes St. John's wort (hypericum perforatum) three times a day for mild depression. The nurse should tell the client that:
Correct Answer: C
Rationale: St. John's wort increases photosensitivity, so sunscreen use may paradoxically increase skin reactions; clients should be cautioned about sun exposure.