NCLEX-RN
NCLEX RN Practice Test Questions
Extract:
Question 1 of 5
The 6-month-old client with a ventral septal defect is receiving Digitalis for regulation of his heart rate. Which finding should be reported to the doctor?
Correct Answer: C
Rationale: A heart rate of 60 bpm in a 6-month-old is too low (normal is 80-160 bpm), indicating possible digitalis toxicity, which should be reported.
Question 2 of 5
A client with multiple sclerosis tires easily, so the nurse is instructing the client in energy-conservation techniques. Which of the following techniques may help the client conserve energy? Select all that apply.
Correct Answer: A,C,D,E
Rationale: Energy conservation for multiple sclerosis includes sitting for tasks (
A), resting regularly (
C), planning movements (
D), and monitoring fatigue (E). Items on the floor or high shelves (
B) increase effort, and pulling vs. pushing (F) is not standard.
Question 3 of 5
A client has accidentally splashed a toxic (although not caustic) substance in his right eye and the nurse must flush the eye. Which of the following steps are correct? Select all that apply.
Correct Answer: B,C,D,E
Rationale: Correct eye irrigation includes syringe 0.5 inch above eye (
B), flushing 5 minutes (
C), holding eyelid open (
D), and using a basin (E). Head down (
A) is incorrect; tilt toward affected side.
Question 4 of 5
The nurse is teaching the client regarding use of sodium warfarin. Which statement made by the client would require further teaching?
Correct Answer: C
Rationale: Aspirin increases bleeding risk when taken with warfarin, indicating a need for further teaching to avoid this combination.
Question 5 of 5
A client has signs of increased intracranial pressure. Which one of the following is an early indicator of deterioration in the client's condition?
Correct Answer: D
Rationale: A decrease in level of consciousness is an early and sensitive indicator of increased intracranial pressure, reflecting cerebral compromise before other signs like pupil changes or vital sign alterations.