NCLEX-RN
NCLEX RN Practice Test Questions
Extract:
Question 1 of 5
The nurse is caring for a client after a laryngectomy. The client is anxious, with a respiratory rate of 32 and an oxygen saturation of 88. The nurse's first action should be to:
Correct Answer: B
Rationale: Low oxygen saturation (88%) and high respiratory rate indicate hypoxemia. Increasing oxygen flow rate is the fastest way to improve oxygenation. Suctioning may be needed later, but oxygen is the priority.
Question 2 of 5
The nurse on an orthopedic unit is assigned to care for four clients with displaced bone fractures. Which client will not be treated with the use of traction?
Correct Answer: D
Rationale: Ankle fractures are typically managed with immobilization or surgery, not traction.
Question 3 of 5
The client is taking rifampin 600 mg po daily to treat his tuberculosis. Which action by the nurse indicates understanding of the medication?
Correct Answer: B
Rationale: Rifampin causes orange-red discoloration of urine, a normal side effect the nurse should explain.
Question 4 of 5
A diabetic multigravida is scheduled for an amniocentesis at 32 weeks gestation to determine the L/S ratio and phosphatidyl glycerol level. The L/S ratio is 1:1 and the presence of phosphatidylglycerol is noted. The nurse's assessment of this data is:
Correct Answer: C
Rationale: An L/S ratio of 1:1 indicates immature fetal lungs, increasing the risk of respiratory distress syndrome, despite the presence of phosphatidylglycerol.
Question 5 of 5
During morning assessments, the nurse finds that a client's nephrostomy tube has been clamped. The nurse's first action should be to:
Correct Answer: C
Rationale: Unclamping the nephrostomy tube is the priority to restore urine flow and prevent obstruction or infection.