NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
A gravida 2 para 1 client delivered a full-term newborn 12 hours ago. The nurse finds her uterus to be boggy, high, and deviated to the right. The most appropriate nursing action is to:
Correct Answer: D
Rationale: A full bladder is the most common cause of uterine displacement; having the client void addresses this before further interventions.
Question 2 of 5
The nurse is ready to begin an exam on a nine-month-old infant who is sitting quietly on his mother's lap. Which should the nurse do first?
Correct Answer: B
Rationale: When examining an infant, the nurse should start with the least invasive procedures to maintain the infant’s calm state. Listening to heart and lung sounds is non-invasive and can be done while the infant is quiet. Checking the Babinski reflex, palpating the abdomen, or checking tympanic membranes may cause discomfort and disrupt the exam.
Question 3 of 5
The nurse is performing an assessment on a client with a history of a thyroidectomy. Which finding suggests the client is experiencing hypocalcemia?
Correct Answer: A
Rationale: Hypocalcemia post-thyroidectomy (due to parathyroid damage) causes muscle twitching or tetany from low calcium levels. Nausea, chest pain, and fever are less specific.
Question 4 of 5
A gravida 2 para 1 client delivered a full-term newborn 12 hours ago. The nurse finds her uterus to be boggy, high, and deviated to the right. The most appropriate nursing action is to:
Correct Answer: D
Rationale: A full bladder is the most common cause of uterine displacement; having the client void addresses this before further interventions.
Question 5 of 5
A client with a history of heart failure is admitted with complaints of edema. The nurse should give priority to:
Correct Answer: A
Rationale: Diuretics reduce edema in heart failure, improving fluid balance and symptoms.