NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
A client with a fractured leg is exhibiting shortness of breath, pain upon deep breathing, and hemoptysis. What do these clinical manifestations indicate to the nurse?
Correct Answer: B
Rationale: Shortness of breath, pleuritic pain, and hemoptysis are classic signs of pulmonary embolus, often associated with immobility from a fracture. CHF (
A) causes edema, ARDS (
C) causes diffuse respiratory failure, and tension pneumothorax (
D) causes tracheal deviation.
Question 2 of 5
The physician has ordered an amniocentesis to determine the L/S ratio. The L/S ratio is a reliable indicator of:
Correct Answer: C
Rationale: The lecithin/sphingomyelin (L/S) ratio assesses fetal lung maturity by measuring surfactant levels in amniotic fluid. A ratio of 2:1 or higher indicates mature lungs reducing the risk of respiratory distress syndrome. It does not assess renal function Rh isoimmunization or anatomical abnormalities.
Question 3 of 5
Early in her ninth month of pregnancy, a client has been diagnosed as having mild preeclampsia. In counseling her about her diet, the nurse must emphasize the importance of:
Correct Answer: D
Rationale: Women with pregnancy-induced hypertension have a reduced plasma volume secondary to venous vessel constriction, not hypovolemia; therefore, sodium restriction is not recommended. It is suggested that these women avoid extremely salty foods. Drinking six to eight glasses of water per day facilitates optimal fluid volume and renal perfusion, but it will not decrease the venous vessel constriction of pregnancy-induced hypertension. Carbohydrate needs increase during pregnancy, specifically during the second and third trimesters, but they have not been linked to pregnancy-induced hypertension. Loss of urinary protein (proteinuria) is associated with increased permeability of the large protein molecules with pregnancy-induced hypertension. Additional dietary protein also helps increase the plasma colloidal osmotic pressure. Diets deficient in protein have been linked to pregnancy-induced hypertension.
Question 4 of 5
A child is to receive atropine 0.15 mg (1/400 g) as part of his preoperative medication. A vial containing atropine 0.4 mg (1/150 g)/mL is on hand. How much atropine should be given?
Correct Answer: B
Rationale: The answer is correct. 0.4 mg = 1 mL : 0.15 mg = x mL, 0.4x = 0.15, x = 0.15 / 0.4, x = 0.375 or 0.38 mL. Sufficient information is provided to determine the amount of atropine to administer. The amount of atropine available and the amount of atropine ordered is required to determine the amount of atropine to be given.
Question 5 of 5
A 27-year-old male client is admitted to the acute care mental health unit for observation. He has recently lost his job, and his wife told him yesterday that she wants a divorce. The client is placed on suicide precautions. In assessing suicide potential, the nurse should pay close attention to the client's:
Correct Answer: C
Rationale: Assessing the client's level of insight is an important part of the mental status exam (MSE), but it does not reflect suicide potential. Assessing the client's thought processes is an important part of the MSE, but it does not reflect suicide potential. Assessing the client's mood and affect is an important part of the MSE, and it can be a very valuable indicator of suicide potential. Frequently a client who has decided to proceed with suicide plans will exhibit a suddenly improved mood and affect. Assessing a client's abstracting abilities is an important part of the MSE, but it does not reflect suicide potential.