NCLEX-RN
NCLEX RN Practice Exam Questions
Extract:
Question 1 of 5
The doctor has ordered neurological checks every 30 minutes for a client injured in a biking accident. Which finding indicates that the client's condition is satisfactory?
Correct Answer: A
Rationale: A Glasgow Coma Scale score of 13 indicates mild brain injury, suggesting a satisfactory condition compared to the other abnormal findings.
Question 2 of 5
The nurse is making initial rounds on a client with a C5 fracture. The client is in a halo vest and is receiving O2 at 40% via mask to a tracheostomy. Assessment reveals a respiratory rate of 40 and O2 saturation of 88. The client is restless. Which initial nursing action is most indicated?
Correct Answer: B
Rationale: Restlessness, tachypnea, and low O2 saturation suggest airway obstruction or secretions. Tracheal suctioning is the initial action to clear the airway and improve oxygenation.
Question 3 of 5
The nursing assistant is taking vitals for a client on mechanical ventilation. Which of the following findings should the nursing assistant report to the nurse immediately?
Correct Answer: D
Rationale: Fever (102.1°F) in a ventilated client suggests infection (e.g., ventilator-associated pneumonia), requiring immediate reporting.
Question 4 of 5
The nurse is caring for a client who is receiving magnesium sulfate for severe preeclampsia. Which of the following findings would indicate magnesium toxicity?
Correct Answer: B
Rationale: absent deep tendon reflexes are a sign of magnesium toxicity, requiring immediate intervention
Question 5 of 5
The nurse is preparing to administer insulin to a client with type 1 diabetes mellitus. The client is to receive 10 units of regular insulin and 20 units of NPH insulin. Which of the following actions by the nurse is correct?
Correct Answer: A
Rationale: regular insulin is drawn up first, followed by NPH, to prevent contamination of the regular insulin with NPH