NCLEX-RN
NCLEX RN Test Bank with Rationales Questions
Extract:
Question 1 of 5
A nursing assistant is taking care of a child in the arm restraint shown below. To provide care for this child, what should the assistant do?
Correct Answer: C
Rationale: The restraint should remain in position. Removing the restraint or untaping the restraint will risk dislodging the I.V.
Question 2 of 5
A client with a history of multiple sclerosis is prescribed interferon beta-1a (Avonex). The nurse should instruct the client to report which of the following side effects immediately?
Correct Answer: B
Rationale: Depression is a serious side effect of interferon beta-1a, requiring immediate reporting due to the risk of worsening mental health.
Question 3 of 5
A client with a history of breast cancer is admitted with bone metastases. The nurse should include which of the following in the plan of care?
Correct Answer: A
Rationale: Bisphosphonates reduce bone resorption and pain in bone metastases.
Question 4 of 5
A client has atrial fibrillation. The nurse should monitor the client for:
Correct Answer: B
Rationale: Atrial fibrillation increases the risk of thromboembolism, leading to cerebrovascular accident (stroke). Cardiac arrest, heart block, and ventricular fibrillation are less directly associated.
Question 5 of 5
When preparing a 3-year-old child for blood specimens to be drawn for laboratory testing, the nurse should?
Correct Answer: C
Rationale: Distraction techniques are most effective for a 3-year-old during painful procedures like blood draws, as they have limited understanding of explanations. Simple preparation may help, but distraction is key.