NCLEX-RN
Free NCLEX RN Exam Practice Questions Questions
Extract:
Question 1 of 5
A nurse is caring for a client with a new colostomy. Which of the following actions should the nurse include in the teaching plan to prevent skin breakdown around the stoma?
Correct Answer: A
Rationale: A skin barrier protects the peristomal skin from irritation caused by stool. Soap can irritate the skin, leaving the pouch off risks exposure, and petroleum jelly is not recommended.
Question 2 of 5
A client is receiving heparin therapy for a pulmonary embolism. The nurse should monitor the client for which of the following adverse effects?
Correct Answer: A
Rationale: Heparin can cause heparin-induced thrombocytopenia, a serious adverse effect that reduces platelet count and increases clotting risk, requiring close monitoring.
Question 3 of 5
The nurse is assessing a client with a suspected pulmonary embolism. Which of the following symptoms is most likely to be present?
Correct Answer: B
Rationale: Sudden chest pain is a common symptom of pulmonary embolism due to impaired blood flow to the lungs.
Question 4 of 5
A client with a history of burns is admitted with a 40% total body surface area injury. The nurse should prioritize which of the following interventions?
Correct Answer: A
Rationale: Fluid resuscitation is the priority to prevent hypovolemic shock in extensive burns.
Question 5 of 5
The nurse is caring for a client with a spinal cord injury at C5. Which complication should the nurse monitor for?
Correct Answer: D
Rationale: A C5 spinal cord injury can cause respiratory distress (diaphragm impairment), urinary retention (loss of bladder control), and pressure ulcers (immobility), requiring comprehensive monitoring.