NCLEX-RN
NCLEX RN SATA Questions Questions
Extract:
Question 1 of 5
A parent reports that her child has developed a bloody nose. Which action should the nurse instruct the parent to take to control the bleeding?
Correct Answer: D
Rationale: The child should be positioned erect, sitting with head tilted forward to avoid blood dripping posteriorly to the pharynx. The soft part of the nose should be tightly pinched against the center wall for 10 minutes, and the parent should be instructed that this pinch should be timed by a clock, not estimated. The parent should be told not to release pressure for 10 minutes. The child is encouraged to remain calm and quiet and to breathe through the mouth.
Question 2 of 5
You are caring for a postoperative client who is complaining of abdominal distention and flatus. Which intervention would you most likely do for this client?
Correct Answer: C
Rationale: A return-flow enema is specifically used to relieve abdominal distention and flatus by introducing and then removing fluid to stimulate gas expulsion.
Question 3 of 5
An obese diabetic client complains of bilateral leg aching. His physician has referred him to cardiac rehabilitation to start an exercise program. Which of the following activities is most helpful for the client?
Correct Answer: A
Rationale: Stationary cycling is low-impact, suitable for an obese diabetic client, minimizing joint stress while improving cardiovascular health.
Question 4 of 5
The nurse is evaluating the pin insertion site of a client's skeletal traction. Which of the following indicate a complication?
Correct Answer: C
Rationale: A moving pin indicates instability, a complication risking infection or poor healing. Crusts and serous drainage are normal, and lack of pain is not a complication.
Question 5 of 5
The nurse is evaluating the client's potential for development of a pressure sore. Which of the following individual characteristics would be the best indicator of risk for the client's developing a pressure sore?
Correct Answer: C
Rationale: Immobility is the primary risk factor for pressure sores, as it leads to prolonged pressure on tissues.