NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
At her monthly prenatal visit, a client reports experiencing heartburn. Which nursing measure should be included in her plan of care to help alleviate it?
Correct Answer: C
Rationale: At least eight glasses of fluid per day are encouraged to help dilute stomach contents, thereby decreasing irritation. Alka Seltzer contains aspirin, which is irritating to gastric mucosa, and therefore should be avoided. Small, frequent bland meals help to decrease gastric pressure and to prevent reflux. Lying down after meals may cause gastric reflux and prevents optimal gastric emptying.
Question 2 of 5
A 74-year-old client seen in the emergency room is exhibiting signs of delirium. His family states that he has not slept, eaten, or taken fluids for the past 24 hours. The planning of nursing care for a delirious client is based on which of the following premises?
Correct Answer: A
Rationale: This answer is correct. If the cause is removed, the delirious client will recover completely. This answer is incorrect. The demented client is incapable of returning to previous level of functioning. The delirious client is capable of returning to previous functioning. This answer is incorrect. The demented client, not the delirious client, has progressive intellectual and behavioral deterioration. This answer is incorrect. Delirium develops rapidly, whereas dementia is insidious.
Question 3 of 5
Which is true regarding the administration of antacids?
Correct Answer: C
Rationale: Antacids can bind to other medications, reducing their absorption, so they should be administered at least 1–2 hours apart from other drugs. Timing with meals depends on the condition, and they are not given with every meal/snack or to enhance other drug absorption.
Question 4 of 5
The nurse is ready to begin an exam on a nine-month-old infant who is sitting quietly on his mother's lap. Which should the nurse do first?
Correct Answer: B
Rationale: When examining an infant, the nurse should start with the least invasive procedures to maintain the infant’s calm state. Listening to heart and lung sounds is non-invasive and can be done while the infant is quiet. Checking the Babinski reflex, palpating the abdomen, or checking tympanic membranes may cause discomfort and disrupt the exam.
Question 5 of 5
The nurse is caring for a client with a history of a spinal fusion. The client complains of back pain. The nurse should:
Correct Answer: D
Rationale: Back pain post-spinal fusion may indicate complications like hardware failure or infection, requiring immediate physician notification. Compresses, rest, and acetaminophen are insufficient.