NCLEX-RN
NCLEX RN Practice Tests Questions
Extract:
Question 1 of 5
The multidisciplinary team decides to implement behavior modification with a client. Which of the following nursing actions is of primary importance during this time?
Correct Answer: A
Rationale: to implement a behavior modification plan successfully, all staff members need to be included in program development, and time must be allowed for discussion of concerns from each nursing staff member; consistency and follow-through is important to prevent or diminish the level of manipulation by the staff or client during implementation of this program
Question 2 of 5
A burn client is in the acute phase of burn care. The nurse assesses jugular vein distention, edema, urine output of 20 cc in 2 hours, and crackles on auscultation. Which order would the nurse anticipate from the physician?
Correct Answer: A
Rationale: Signs of fluid overload (JVD, edema, low urine output, crackles) suggest the need for furosemide (Lasix) to reduce excess fluid and prevent pulmonary edema.
Question 3 of 5
A pregnant client is keeping a 'kick count' log during the last trimester. Which of the following may indicate fetal distress?
Correct Answer: C
Rationale: Fewer than 10 movements in 2 hours (
C) suggests fetal distress, as normal is >10 movements in 2 hours. Other options (A, B,
D) set incorrect thresholds.
Question 4 of 5
As the client reaches 6cm dilation, the nurse notes late decelerations on the fetal monitor. What is the most likely explanation of this pattern?
Correct Answer: D
Rationale: Late decelerations indicate uteroplacental insufficiency, reducing fetal oxygenation during contractions.
Question 5 of 5
A client with schizophrenia spends much of his time pacing the floor, rocking back and forth, and moving from one foot to another. The client's behaviors are an example of:
Correct Answer: C
Rationale: Akathisia is characterized by restlessness and constant movement, often a side effect of antipsychotic medications, as described.