NCLEX-RN
NCLEX RN Practice Questions Questions
Extract:
Question 1 of 5
On the second post-operative day after a subtotal thyroidectomy, the client tells the nurse, 'I feel numbness and my face is twitching.' What is the nurse's best initial action?
Correct Answer: C
Rationale: Numbness and facial twitching suggest hypocalcemia due to parathyroid gland damage during thyroidectomy, requiring immediate physician notification for calcium supplementation.
Question 2 of 5
The nurse is performing discharge instruction for a client with an implantable permanent pacemaker. What discharge instruction is an essential part of the plan?
Correct Answer: C
Rationale: Clients with pacemakers must monitor their pulse to ensure the device is functioning correctly and to detect irregularities, making pulse-taking an essential discharge instruction.
Question 3 of 5
The nurse has just received the shift report and is preparing to make rounds. Which client should be seen first?
Correct Answer: C
Rationale: The client with shortness of breath is at highest risk for respiratory distress and requires immediate assessment.
Question 4 of 5
The nurse is monitoring a client following a lung resection. The hourly output from the chest tube was 300 mL. The nurse should give priority to:
Correct Answer: D
Rationale: A chest tube output of 300 mL per hour is excessive and may indicate hemorrhage, requiring immediate physician notification.
Question 5 of 5
A nurse is administering a blood transfusion to a client on the oncology unit. Which clinical manifestation indicates an acute hemolytic reaction to the blood?
Correct Answer: A
Rationale: Low back pain is a hallmark of acute hemolytic transfusion reaction due to hemolysis and kidney involvement. Fever, urticaria, or neck vein distention suggest other complications.