NCLEX-PN
NCLEX Trainer Test 1 Questions
Extract:
Question 1 of 5
An extremely agitated client is receiving haloperidol (Haldol) IM every 30 minutes while in the psychiatric emergency room.
Correct Answer: A
Rationale: Haloperidol can cause postural hypotension due to alpha-adrenergic blockade, especially during rapid neuroleptization. Monitoring vital signs, particularly blood pressure, every 30 minutes ensures client safety. Reassurance, education, and monitoring side effects are secondary to physiological stability.
Extract:
A patient has a Sengstaken-Blakemore tube in place. The nurse enters the room and finds the woman in respiratory distress.
Question 2 of 5
It is MOST important for the nurse to
Correct Answer: C
Rationale: Strategy: Answers are all implementations. Determine the outcome of each answer choice. Is it desired? (1) need to remove tube immediately to provide for airway (2) does not provide a patent airway (3) correct-scissors always secured at the bedside, remove tube if observe signs of respiratory distress or airway obstruction caused by upward displacement of esophageal balloon (4) unnecessary to call code until respiratory arrest occurs, then establish a patent airway first
Extract:
Question 3 of 5
A client with pernicious anemia is admitted. What would the nurse expect the admitting assessment to reveal?
Correct Answer: B
Rationale: Pernicious anemia, a vitamin B12 deficiency, often causes neurological symptoms like bilateral leg neuropathy due to nerve demyelination.
Question 4 of 5
The client with a suspected pituitary tumor will most likely exhibit symptoms of:
Correct Answer: A
Rationale: Pituitary tumors can compress the optic chiasm, leading to visual disturbances. Diarrhea , blood glucose changes , and urticaria are less commonly associated with pituitary tumors.
Question 5 of 5
The nurse is caring for a client who is postoperative day 1 after a gastrectomy. Which of the following findings would be of GREATest concern to the nurse?
Correct Answer: A
Rationale: A temperature of 100.8°F suggests infection, a serious complication post-gastrectomy due to risk of anastomotic leak, requiring immediate evaluation. Options B, C, and D are expected: incision pain, NG tube output, and urine output 40 mL/hour are normal on day 1.