NCLEX-RN
NCLEX RN Nursing Exam Questions
Extract:
Question 1 of 5
A client with a history of a stroke is being taught to use a quad cane. The nurse should teach the client to:
Correct Answer: C
Rationale: The quad cane should be used on the weak side to support the affected leg post-stroke, improving balance. Holding in the strong hand or advancing with the strong leg is incorrect.
Question 2 of 5
A client sustained second- and third-degree burns to his face, neck, and upper chest. Which of the following nursing diagnoses would be given the highest priority in the first 8 hours' postburn?
Correct Answer: D
Rationale: Alteration in airway integrity is the highest priority for this client in the first 8 hours postburn. Failure to continually assess this client's airway status could result in poor ventilation and oxygenation, in addition to an inability to intubate the client secondary to excessive edema formation in the neck.
Question 3 of 5
The nurse is caring for a client with a diagnosis of gestational trophoblastic disease. Which laboratory value is most likely to be elevated?
Correct Answer: A
Rationale: Gestational trophoblastic disease (e.g. molar pregnancy) causes markedly elevated hCG levels due to abnormal trophoblastic tissue growth. AFP estriol and progesterone are not typically elevated in this condition.
Question 4 of 5
The nurse is caring for a client with a diagnosis of postpartum endometritis. Which intervention is most appropriate?
Correct Answer: A
Rationale: Postpartum endometritis is treated with antibiotics to address the uterine infection. Fetal heart tones are irrelevant postpartum cesarean delivery is not indicated and tocolytics are for preterm labor.
Question 5 of 5
The nurse is caring for a client with a history of hypothyroidism. The nurse should expect the client to have:
Correct Answer: A
Rationale: Hypothyroidism slows metabolism, causing fatigue, weight gain, and cold intolerance.