NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
As the client reaches 6cm dilation,the nurse notes late decelerations on the fetal monitor. What is the most likely explanation of this pattern?
Correct Answer: D
Rationale: Late decelerations indicate uteroplacental insufficiency where reduced placental blood flow during contractions causes fetal hypoxia. Cord compression causes variable decelerations head compression causes early decelerations and sleep does not cause decelerations.
Question 2 of 5
The client is admitted with a diagnosis of gestational trophoblastic disease. Which vital sign change is most likely to be observed?
Correct Answer: A
Rationale: Gestational trophoblastic disease can cause maternal tachycardia due to elevated hCG or bleeding. Fetal bradycardia is not relevant (no viable fetus) and hypotension is less common unless hemorrhage occurs.
Question 3 of 5
A husband asks if he can visit with his wife on her ECT treatment days and what to expect after the initial treatment. The nurse's best response is:
Correct Answer: D
Rationale: A family member is encouraged to stay with the client after return to the unit. The nurse has used an opportunity to do family teaching and allay fears by explaining temporary side effects of the treatment.
Question 4 of 5
The nurse is caring for a client with a history of multiple sclerosis. Which intervention is most appropriate to prevent complications?
Correct Answer: C
Rationale: Hot baths can exacerbate multiple sclerosis symptoms by increasing body temperature, causing fatigue or weakness. Weight-bearing exercise is encouraged, antibiotics are not routine, and fluid restriction is harmful.
Question 5 of 5
A 22-year-old client who is being seen in the clinic for a possible asthma attack stops wheezing suddenly as the nurse is doing a lung assessment. Which one of the following nursing interventions is most important?
Correct Answer: D
Rationale: During impending respiratory failure or asthmatic complications, the client is placed in the high-Fowler position to facilitate comfort and promote optimal gas exchange. Arterial blood gases are monitored in the treatment of respiratory failure during an asthma attack, but it is not an initial intervention. O2 therapy is used during an asthma attack, but it is not the initial intervention. The usual prescribed amount is a cautiously low flow rate of 1-2 L/min. Wheezing is a characteristic clinical finding during an asthma attack. If wheezing suddenly ceases, it usually indicates a complete airway obstruction and requires immediate treatment for respiratory failure or arrest.