NCLEX Questions, NCLEX-RN Exam Practice Questions, NCLEX-RN Questions, Nurselytic

Questions 157

NCLEX-RN

NCLEX-RN Test Bank

NCLEX-RN Exam Practice Questions

Extract:


Question 1 of 5

The nurse is assessing a client with suspected meningitis. Which finding is most concerning?

Correct Answer: A

Rationale: Neck stiffness (nuchal rigidity) is a hallmark sign of meningitis, indicating meningeal irritation and requiring urgent evaluation. Fever, photophobia, and headache are common but less specific without neck stiffness.

Question 2 of 5

A client is having an amniocentesis. Prior to the procedure, an ultrasound is performed. In preparing the client, the nurse explains the reason for a sonogram in this situation to be:

Correct Answer: C

Rationale: Prior to amniocentesis, the abdomen is scanned by ultrasound to locate the placenta, thus reducing the possibility of penetrating it with the spinal needle used to obtain amniotic fluid.

Question 3 of 5

The nurse is caring for a client with a history of a ventricular septal defect. Which finding should be reported to the doctor immediately?

Correct Answer: D

Rationale: Cyanosis in a ventricular septal defect indicates significant shunting and hypoxemia, a critical finding requiring immediate reporting. Murmurs, tachycardia, and fatigue are expected but less urgent.

Question 4 of 5

A client's behavior is annoying other clients on the unit. He is meddling with their belongings and dominating the group. The best approach by the nurse is to:

Correct Answer: B

Rationale: Consistent limit setting will help the client to know what is acceptable behavior, addressing the disruptive actions effectively.

Question 5 of 5

A 2-month-old infant is receiving IV fluids with a volume control set. The nurse uses this type of tubing because it:

Correct Answer: C

Rationale: A volume control set allows the nurse to control the amount of fluid administered over a set period.

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