NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
A client with a history of rheumatoid arthritis is admitted with a flare-up. The nurse should include which of the following in the plan of care?
Correct Answer: A
Rationale: NSAIDs reduce inflammation and pain during rheumatoid arthritis flare-ups.
Question 2 of 5
The nurse is making rounds and observes a client who is unconscious (see fi gure). The nursing assistant has just turned the client from lying on her back. Before raising the side rail, the nurse should:
Correct Answer: C
Rationale: The client is positioned correctly in the side-lying position. The pillows support the client’s joints and do not cause unnecessary pressure on the joints or skin. It is not necessary to add another pillow under the arm or to elevate the head of the bed. The nurse should assess the client’s skin for signs of breakdown, particularly at the elbows, back, hips, and heels where there were pressure points from the position in which the client was previously lying.
Question 3 of 5
A 3-month-old is admitted to the pediatric unit with moderate dehydration. The nurse should assess the client for:
Correct Answer: B, C
Rationale: Moderate dehydration in an infant is indicated by a rapid, thready pulse and decreased skin elasticity due to fluid loss.
Question 4 of 5
A multiparous client 48 hours postpartum who is breast-feeding tells the nurse, 'I'm having a lot of cramping. This didn't happen when I nursed my first baby,' which of the following would be the nurse's best response?
Correct Answer: D
Rationale: Breast-feeding stimulates oxytocin release, causing uterine contractions and cramping, which is normal and often more noticeable in multiparous women.
Question 5 of 5
The nurse assesses a client who is receiving a tube feeding. Which of the following situations would require prompt intervention from the nurse?
Correct Answer: B
Rationale: A feeding hanging for 8 hours poses an infection risk due to bacterial growth, requiring prompt intervention.