NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
The day following his admission, the nurse sits down by a male client on the sofa in the dayroom. He was admitted for depression and thoughts of suicide. He looks at the nurse and says, 'My life is so bad no one can do anything to help me.' The most helpful initial response by the nurse would be:
Correct Answer: C
Rationale: This response does not acknowledge the client's feelings and may increase his feelings of guilt. This response denotes false reassurance. This response acknowledges the client's feelings and invites a response. This response changes the subject and does not allow the client to talk about his feelings.
Question 2 of 5
Based on your knowledge of genetic inheritance, which of these statements is true for autosomal recessive genetic disorders?
Correct Answer: D
Rationale: If both parents are affected by the disorder and are not just carriers, then all their children would manifest the same disorder.
Question 3 of 5
A 24-hours' postpartum client complains of discomfort at the episiotomy site. On assessment, the nurse notes the episiotomy is without signs of infection. To relieve the discomfort, the nurse should first:
Correct Answer: A
Rationale: Warm, moist heat will promote circulation and provide comfort. A sitz bath should be tried before medication is given. Pain medication can be given when other comfort measures such as a sitz bath and topical applications are ineffective. Kegel exercises facilitate sitting by decreasing tension on the episiotomy. They will not be effective for pain control or sustained comfort level. Ice packs are appropriate to apply in the first 12 hours post-delivery to produce vasoconstriction and to reduce edema to the area.
Question 4 of 5
A client is pregnant for the fourth time and has had three normal vaginal deliveries. She is in active labor and fully dilated. Suddenly she calls, 'Nurse, the baby is coming.' As the nurse responds to her call, which one of the following observations should the nurse make first?
Correct Answer: A
Rationale: The nurse must assess the labor status to determine if birth is imminent. The nurse may note perineal bulging, crowning, or birth of the head to ascertain labor status. Assessing uterine contractions is one intervention to ascertain labor status. Based on the client's cry, it is not the intervention of choice. If delivery of the infant is imminent, preparing a clean or sterile area for delivery is appropriate, but labor status must be established, whether delivery is imminent, by perineal assessment. Assessing FHR is one intervention to ascertain fetal well-being. Based on the client's cry, this is not the intervention of choice.
Question 5 of 5
A client has been instructed in how to take her nitroglycerin tablets. The nurse giving her instructions knows the client understands the information when she tells her:
Correct Answer: C
Rationale: Headaches may occur after taking nitroglycerin because of vasodilation. The tablets do not need to be refrigerated. The client should carry them with her. The client should contact the physician if repeated doses of nitroglycerin do not relieve the discomfort. Nitroglycerin tablets should be dissolved under the tongue, not swallowed.