NCLEX-RN
Practice NCLEX RN Test Questions
Extract:
Question 1 of 5
A client with AIDS is admitted with a diagnosis of pneumocystis carinii pneumonia. Shortly after his admission, he becomes confused and disoriented. He attempts to pull out his IV and refuses to wear an O2 mask. Based upon his mental status, the priority nursing diagnosis is:
Correct Answer: B
Rationale: The client's confusion and disorientation pose a risk for injury, such as pulling out the IV or falling, making this the priority nursing diagnosis.
Question 2 of 5
A client is admitted with a possible bowel obstruction. Which question during the nursing history is least helpful in obtaining information regarding this diagnosis?
Correct Answer: C
Rationale: Diet history is less directly related to diagnosing a bowel obstruction compared to pain, vomiting characteristics, or abdominal distension, which are hallmark symptoms.
Question 3 of 5
The nurse is caring for a client who is receiving mechanical ventilation. The ventilator alarms are sounding, and the nurse notes high-pressure alarms. Which of the following actions should the nurse take FIRST?
Correct Answer: C
Rationale: checking for kinks in the tubing is the first step, as it is a common cause of high-pressure alarms
Question 4 of 5
The nurse is assigned to care for the client with a Steinmen pin. During pin care, she notes that the LPN uses sterile gloves and Q-tips to clean the pin. Which action should the nurse take at this time?
Correct Answer: A
Rationale: Sterile technique is appropriate for pin care; assisting maintains the sterile field.
Question 5 of 5
The nurse has received report on the day's assigned clients. Which of the following clients should the nurse see first?
Correct Answer: D
Rationale: Tingling around the mouth after an antibiotic suggests an allergic reaction, potentially anaphylaxis, requiring immediate assessment.