NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
A client with a history of a stroke is receiving tPA (alteplase). The nurse should:
Correct Answer: A
Rationale: tPA, a thrombolytic, increases bleeding risk, requiring close monitoring for signs like hematuria or hematoma. It’s given over 1 hour, glucose is unrelated, and fluids are not restricted.
Question 2 of 5
A 2-year-old child with a scalp laceration and subdural hematoma of the temporal area as a result of falling out of bed should be prevented from:
Correct Answer: A
Rationale: A child with a subdural hematoma has increased ICP. Crying may significantly increase this pressure.
Question 3 of 5
An 11-month-old infant is admitted with a possible diagnosis of pyloric stenosis. Which of the following best describes the characteristic clinical manifestations of pyloric stenosis?
Correct Answer: D
Rationale: There is no evidence of pain in infants with pyloric stenosis whether eating or not. There are both good appetite and feeding habits in these children. Because of regurgitation, there is usually decreased frequency and quantity of stools and also signs of dehydration and weight loss. Along with upper abdominal distention, there is a characteristic palpable olive-shaped mass located to the right of the umbilicus.
Question 4 of 5
The client is admitted with a diagnosis of gestational trophoblastic disease. Which diagnostic test is most likely to be ordered?
Correct Answer: C
Rationale: Serum hCG levels are markedly elevated in gestational trophoblastic disease and ultrasound reveals a characteristic “snowstorm” pattern or grape-like vesicles. Both tests are essential for diagnosis.
Question 5 of 5
Following a fracture of the left femur, a client develops symptoms of osteomyelitis. During the acute phase of osteomyelitis, nursing care is directed toward:
Correct Answer: A
Rationale: Any movement of the affected limb will cause discomfort to the child, so careful handling is essential during the acute phase.