NCLEX-RN
NCLEX RN Practice Tests Questions
Extract:
Question 1 of 5
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with an acute exacerbation. The nurse notes that the client has a respiratory rate of 28 breaths per minute, is using accessory muscles, and has oxygen saturation of 88% on 2 L/min of oxygen via nasal cannula. Which of the following actions should the nurse take FIRST?
Correct Answer: C
Rationale: positioning in high Fowler’s facilitates breathing and improves oxygenation immediately; other actions may follow based on further assessment
Question 2 of 5
A client on a 72-hour psychiatric hold experiences a panic attack while getting ready for the day. The nurse should provide the following interventions ranked by priority:
Order the Items
Source Container
Correct Answer: A,D,C,E,B
Rationale: Priority order: Stay with the client (
A) for safety, reduce stimuli (
D) to calm the environment, instruct deep breathing (
C) to manage symptoms, develop coping mechanisms (E) for future prevention, and incorporate physical activity (
B) as a long-term strategy.
Question 3 of 5
The multidisciplinary team decides to implement behavior modification with a client. Which of the following nursing actions is of primary importance during this time?
Correct Answer: A
Rationale: to implement a behavior modification plan successfully, all staff members need to be included in program development, and time must be allowed for discussion of concerns from each nursing staff member; consistency and follow-through is important to prevent or diminish the level of manipulation by the staff or client during implementation of this program
Question 4 of 5
Along with traditional therapy, a client asks the nurse about alternative therapies for chronic pain. Which could the nurse provide to the client?
Correct Answer: A, B, C, D
Rationale: Yoga, acupuncture, music therapy, and hypnosis are all recognized alternative therapies for managing chronic pain, complementing traditional treatments.
Question 5 of 5
A client has been on prolonged bedrest following surgery. The nurse notes that the patient has pain in the right calf on palpation with dorsiflexion of the ankle. Which of the following causes does the nurse suspect?
Correct Answer: D
Rationale: Calf pain with dorsiflexion (Homan's sign) suggests deep vein thrombosis (
D), common after prolonged bedrest. Arthritis (
A), muscle strain (
B), and compartment syndrome (
C) present differently.