NCLEX-RN
NCLEX RN Practice Questions
Extract:
Question 1 of 5
The nurse caring for a client with myasthenia gravis recognizes which of the following as the priority nursing diagnosis?
Correct Answer: C
Rationale: Myasthenia gravis causes muscle weakness, including respiratory muscles, making ineffective airway clearance the priority due to risk of respiratory failure.
Question 2 of 5
The nurse has an order to administer a heparin drip at 12 units/kg/hr. The client weighs 178 pounds. The heparin is available as 25,000 units in 500 mL D5W. At which rate should the nurse program the pump?
Correct Answer: 11.3
Rationale: Weight: 178 lbs ÷ 2.2 = 80.91 kg. Dose: 80.91 × 12 = 970.92 units/hr. Concentration: 25,000 units ÷ 500 mL = 50 units/mL. Rate: 970.92 ÷ 50 = 19.42 mL/hr (rounded to 19.4 mL/hr).
Question 3 of 5
A client with rheumatoid arthritis is receiving injections of Myochrysine (gold sodium thiomalate). Before administering the client's medication, the nurse should:
Correct Answer: A
Rationale: Checking lab work is essential to monitor for toxicity, such as renal or hematologic effects, from gold therapy.
Question 4 of 5
The nurse is discussing cigarette smoking with an emphysema client. The client states, 'I don't know why I should worry about cancer.' The nurse's response is based on the fact that the most important reason for a client with emphysema to avoid smoking is that it:
Correct Answer: C
Rationale: Smoking destroys lung parenchyma in emphysema, worsening alveolar damage and impairing gas exchange, making it the primary reason to avoid smoking.
Question 5 of 5
A tornado warning has been issued in the area surrounding the hospital. Which action by the nurse is most appropriate to ensure client safety?
Correct Answer: B
Rationale: Moving clients to the hallway, closing blinds, and shutting doors minimizes risks from flying debris and broken windows during a tornado.