Questions 150

NCLEX-RN

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Extract:


Question 1 of 5

The client with borderline personality disorder spends much time around the nurse's station, making numerous minor requests. The nurse interprets these behaviors as indicating which of the following?

Correct Answer: A

Rationale: Frequent requests and presence at the nurse's station in borderline personality disorder often reflect fears of abandonment and attention-seeking behaviors, characteristic of the disorder.

Question 2 of 5

The nurse is assessing a newborn 24 hours after birth. Which finding requires immediate reporting?

Correct Answer: D

Rationale: Yellowing of the skin within 24 hours suggests pathological jaundice, requiring immediate evaluation to prevent complications like kernicterus.

Question 3 of 5

The nurse is caring for a client with a chest tube. Which of the following findings requires immediate intervention?

Correct Answer: B

Rationale: Clamping the tubing near the insertion site can cause a tension pneumothorax, requiring immediate correction.

Question 4 of 5

A client with asthma has been prescribed beclomethasone (Beclovent) via metered-dose inhaler. To determine if the client has been rinsing the mouth after each use of the inhaler, the nurse should inspect the client's mouth for:

Correct Answer: B

Rationale: Beclomethasone, an inhaled corticosteroid, can cause oral candidiasis (thrush) if the mouth is not rinsed after use, as residual medication promotes fungal growth.

Question 5 of 5

The nurse notices drops of a liquid on the hallway floor of a health care facility. The nurse should do which of the following first?

Correct Answer: C

Rationale: Posting 'wet floor' signs first ensures immediate safety by alerting others to the hazard, preventing slips.
Then, the nurse can proceed with cleanup or notify appropriate personnel.

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