NCLEX-RN
NCLEX RN Practice Test Questions
Extract:
Question 1 of 5
During morning assessments, the nurse finds that a client's nephrostomy tube has been clamped. The nurse's first action should be to:
Correct Answer: C
Rationale: Unclamping the nephrostomy tube is the priority to restore urine flow and prevent obstruction or infection.
Question 2 of 5
A client in Dunlop traction experiences numbness of the thumb and index finger and cannot move the thumb to touch the tips of the other fingers. The capillary refill time is four seconds. Which of the following actions is indicated?
Correct Answer: A
Rationale: Numbness, impaired thumb movement, and delayed capillary refill suggest compression from a tight elastic bandage. Removing and reapplying it loosely (
A) addresses this. Adjusting weights (B,
D) or countertraction (
C) does not address the symptoms.
Question 3 of 5
Which of the following findings would be expected in the infant with biliary atresia?
Correct Answer: C
Rationale: Biliary atresia causes abdominal distention due to bile accumulation and poor weight gain due to malabsorption.
Question 4 of 5
While performing a neurological assessment on a client with a closed head injury, the nurse notes a positive Babinski reflex. The nurse should:
Correct Answer: D
Rationale: A positive Babinski reflex in an adult with a head injury suggests neurological damage, warranting immediate physician notification.
Question 5 of 5
After attending a company picnic, several clients are admitted to the emergency room with E. coli food poisoning. The most likely source of infection is:
Correct Answer: A
Rationale: Undercooked hamburger is a common source of E. coli, particularly strains like O157:H7, which can contaminate ground beef.