NCLEX-RN
NCLEX Practice Test RN Questions
Extract:
Question 1 of 5
The client returns to the unit from surgery with a blood pressure of 90/50, pulse 132, respirations 30. Which action by the nurse should receive priority?
Correct Answer: B
Rationale: Hypotension (BP 90/50), tachycardia (pulse 132), and tachypnea (respirations 30) indicate potential shock or hemorrhage post-surgery, requiring immediate physician notification. Monitoring is secondary, and delegating or asking about feelings delays intervention.
Question 2 of 5
The nurse would need to monitor the serum glucose levels of a client receiving which of the following medications, owing to its effects on glycogenolysis and insulin release?
Correct Answer: D
Rationale: Norepinephrine's side effects are primarily related to safe, effective care environment and include decreased peripheral perfusion and bradycardia. Dobutamine's side effects include increased heart rate and blood pressure, ventricular ectopy, nausea, and headache. Propranolol's side effects include elevated blood urea nitrogen, serum transaminase, alkaline phosphatase, and lactic dehydrogenase. Epinephrine increases serum glucose levels by increasing glycogenolysis and inhibiting insulin release. Prolonged use can elevate serum lactate levels, leading to metabolic acidosis, increased urinary catecholamines, false elevation of blood urea nitrogen, and decreased coagulation time.
Question 3 of 5
The nurse is teaching a client with a history of osteoporosis about fall prevention. The nurse should tell the client to:
Correct Answer: A
Rationale: Removing clutter prevents falls in osteoporosis, reducing fracture risk.
Question 4 of 5
A client with a history of chronic lymphocytic leukemia is admitted with complaints of fever. The nurse should give priority to:
Correct Answer: A
Rationale: Fever in chronic lymphocytic leukemia suggests possible infection, a serious complication due to immunosuppression, so monitoring for infection is the priority.
Question 5 of 5
The client is admitted with a diagnosis of postpartum depression. Which vital sign change is most likely to be observed?
Correct Answer: A
Rationale: Postpartum depression is a psychological condition and typically does not cause vital sign changes. Fever tachycardia or hypotension suggest physical conditions like infection or hemorrhage.