NCLEX-RN
NCLEX Practice Test RN Questions
Extract:
Question 1 of 5
A newborn infant is exhibiting signs of respiratory distress. Which of the following would the nurse recognize as the earliest clinical sign of respiratory distress?
Correct Answer: C
Rationale: Sternal and subcostal retractions are the earliest sign of respiratory distress in newborns, indicating increased ventilatory effort.
Question 2 of 5
The nurse needs to be aware that the most common early complication of a myocardial infarction is:
Correct Answer: D
Rationale: Myocardial infarction causes tissue damage, which may interrupt electrical impulses. Myocardial irritability results from lack of oxygenated tissue.
Question 3 of 5
Which of the following procedures is necessary to establish a definitive diagnosis of breast cancer?
Correct Answer: D
Rationale: Diaphanography, also known as transillumination, is a painless, noninvasive imaging technique that involves shining a light source through the breast tissue to visualize the interior. It must be used in conjunction with a mammogram and physical examination. Mammography is a useful tool for screening but is not considered a means of diagnosing breast cancers. Thermography is a pictorial representation of heat patterns on the surface of the breast. Breast cancers appear as a 'hot spot' owing to their higher metabolic rate. Biopsy either by needle aspiration or by surgical incision is the primary diagnostic technique for confirming the presence of cancer cells.
Question 4 of 5
The nurse is caring for a client with leukemia who is receiving the drug doxorubicin (Adriamycin). Which toxic effects of this drug would be reported to the physician immediately?
Correct Answer: A
Rationale: Rales and distended neck veins suggest cardiotoxicity (e.g., heart failure), a serious doxorubicin side effect requiring immediate reporting. Red urine (
B) is expected, nausea/vomiting (
C) are common, and BUN/skin changes (
D) are less urgent.
Question 5 of 5
In assessing the nature of the stool of a client who has cystic fibrosis, what would the nurse expect to see?
Correct Answer: B
Rationale: Clay-colored stools indicate dysfunction of the liver or biliary tract. In the early stages of cystic fibrosis, fat absorption is primarily affected resulting in fat, foul, frothy, bulky stools. Dark brown stools indicate normal passage through the colon. Blood-tinged stools indicate dysfunction of the gastrointestinal (GI) tract.