NCLEX-RN
Free NCLEX RN Practice Test Questions
Extract:
Question 1 of 5
The client is admitted to the ER with multiple rib fractures on the right. The nurse's assessment reveals that an area over the right clavicle is puffy and that there is a 'crackling' noise with palpation. The nurse should further assess the client for which of the following problems?
Correct Answer: B
Rationale: The 'puffy' area and 'crackling' noise (crepitus) with palpation are classic signs of subcutaneous emphysema, where air is trapped under the skin, often due to a pneumothorax or rib fractures allowing air to escape into subcutaneous tissue.
Question 2 of 5
A client in ICU has a chest tube, and the nurse is assessing the chest tube drainage system. The nurse notices intermittent bubbling in the water seal chamber. What action should the nurse take?
Correct Answer: B
Rationale: Intermittent bubbling in the water seal chamber is normal during inspiration/expiration or coughing, indicating a patent system. It should be documented as a normal finding.
Question 3 of 5
An adolescent client hospitalized with anorexia nervosa is described by her parents as 'the perfect child.' When planning care for the client, the nurse should:
Correct Answer: B
Rationale: Activities fostering self-identity address the underlying issues of low self-esteem and perfectionism common in anorexia nervosa.
Question 4 of 5
The nurse is at the nurses' station charting when a physician comes up and says, 'Since you are already logged into the computer, I need you to look up some labs on a client.' The client is not cared for by this nurse. Which response by the nurse is most appropriate?
Correct Answer: D
Rationale: Accessing a client's lab results without authorization violates HIPAA, as the nurse is not assigned to the client. The charge nurse can ensure proper access.
Question 5 of 5
A diagnosis of multiple sclerosis is often delayed because of the varied symptoms experienced by those affected with the disease. Which symptom is most common in those with multiple sclerosis?
Correct Answer: B
Rationale: Double vision (diplopia) is a common early symptom of multiple sclerosis due to demyelination affecting cranial nerves, particularly the optic and oculomotor nerves.