NCLEX-PN
NCLEX-PN Practice Questions PDF Questions
Extract:
Question 1 of 5
The client, admitted to a surgical unit following a TURF, has a C81 running. The nurse assesses the client's urine and finds dark red urine containing several small clots. Which intervention should the nurse implement?
Correct Answer: A
Rationale: A. If the urine is dark red, the flow rate of the CBI should be increased. The purpose of the CBI is to remove clots from the bladder and to ensure drainage of urine through the urinary catheter. The flow rate of the CBI fluid should be set so that the outflow remains free from clots and remains light red to pink. B. Stopping the CBI would increase the risk that the urinary catheter would become blocked and the flow of urine interrupted. C. There is no need to manually irrigate a catheter If a C81 is flowing, unless the urinary catheter becomes obstructed. D. Deflating the urinary catheter balloon would be contraindicated because this could result in dislodging the catheter.
Question 2 of 5
Before suctioning a client with a tracheostomy, which nursing action should the nurse perform first?
Correct Answer: C
Rationale: Administering 100% oxygen (hyperoxygenation) for 1-2 minutes before suctioning helps prevent hypoxia during the procedure, which can cause desaturation.
Question 3 of 5
Which action by the nurse is most appropriate while assessing the neurologic function of a client who has a freshly applied plaster cast to the lower extremity?
Correct Answer: A
Rationale: Asking the client to wiggle the toes assesses motor function, ensuring no nerve compression from the cast.
Question 4 of 5
The nurse is caring for a client with a new colostomy. Which statement by the client indicates a need for further teaching?
Correct Answer: B
Rationale: High-fiber foods can cause blockages in a new colostomy; low-residue foods are recommended initially.
Question 5 of 5
If a client has been taking corticosteroid medication for a prolonged period, which statement provides the best indication that the danger related to this medication is understood?
Correct Answer: A
Rationale: Abruptly stopping corticosteroids can cause adrenal insufficiency, a life-threatening condition, indicating the client understands this risk.