NCLEX-RN
NCLEX RN Practice Questions Free Questions
Extract:
Question 1 of 5
Following the delivery of a healthy newborn, a client has developed thrombophlebitis and is receiving heparin IV. What are the signs and symptoms of a heparin overdose for which the nurse would need to observe during postpartum care of the client?
Correct Answer: D
Rationale: Hematuria, ecchymosis, and epistaxis are the most common signs and symptoms of a heparin overdose, indicating bleeding tendencies.
Question 2 of 5
The nurse is caring for a client with a history of Sjögren’s syndrome. The nurse should expect the client to have:
Correct Answer: A
Rationale: Sjögren’s syndrome is an autoimmune condition causing reduced salivary and lacrimal gland function, leading to dry eyes and mouth.
Question 3 of 5
The client with a history of epilepsy is prescribed valproic acid (Depakote). Which laboratory test should the nurse monitor?
Correct Answer: A
Rationale: Valproic acid can cause hepatotoxicity, so liver function tests (e.g., AST, ALT) are monitored regularly. Renal function, blood counts, and electrolytes are less commonly affected.
Question 4 of 5
The nurse caring for a client with closed chest drainage notes that the collection chamber is full.
Correct Answer: D
Rationale: A full collection chamber requires replacing the chest drainage unit to maintain effective drainage and prevent complications like tension pneumothorax.
Question 5 of 5
One afternoon 3 weeks into his alcohol treatment program, a client says to the nurse, 'It's really not all my fault that I have a drinking problem. Alcoholism runs in my family. Both my grandfather and father were heavy drinkers.' The nurse's best response would be:
Correct Answer: B
Rationale: Focusing is an effective therapeutic strategy. This response, however, allows the client to 'defocus' off the topic of learning how to accept responsibility for his behavior and future growth. The nurse can educate the client about both the 'genetic risk' for the development of alcoholism and ways to make long-term healthy lifestyle changes. This response is inappropriately confrontational and condescending to the client. Reflection of content can be an effective verbal therapeutic technique. It is used inappropriately here.