NCLEX-RN
Free NCLEX RN Practice Questions Questions
Extract:
Question 1 of 5
An ICU nurse monitors a client recovering from a head injury. The client's intracranial pressure (ICP) has been between 15 and 19 mmHg throughout the shift. However, after the nurse suctions the client's endotracheal tube, the ICP jumps to 28 mmHg. It decreases a few minutes later to 20 mmHg. The best intervention by the nurse is to
Correct Answer: D
Rationale: A sudden ICP spike to 28 mmHg post-suctioning suggests a significant issue (e.g., impaired cerebral perfusion). The physician should be contacted for evaluation.
Question 2 of 5
The client pulls out the chest tube and fails to report the occurrence to the nurse. When the nurse discovers the incidence, he should take which initial action?
Correct Answer: C
Rationale: Covering the insertion site with Vaseline gauze prevents air entry into the pleural space, stabilizing the client until further intervention.
Question 3 of 5
A client is admitted with suspected Hodgkin's lymphoma. The diagnosis is confirmed by the:
Correct Answer: B
Rationale: Hodgkin's lymphoma is diagnosed by the presence of Reed-Sternberg cells, large abnormal cells found in lymph node biopsies.
Question 4 of 5
Which person is at greatest risk for developing Lyme's disease?
Correct Answer: D
Rationale: Landscapers are at higher risk for Lyme disease due to frequent exposure to tick-infested outdoor environments, where the disease is transmitted.
Question 5 of 5
The nurse is preparing to administer streptomycin 0.25 g. The directions say to reconstitute with 9 mL of sterile water for a concentration of 400 mg/2 mL. How many mLs will the nurse give? Fill in the blank.
Correct Answer: 1.25 mL
Rationale: Dose: 0.25 g = 250 mg. Concentration: 400 mg/2 mL = 200 mg/mL. Volume = 250 mg ÷ 200 mg/mL = 1.25 mL.