NCLEX-PN
NCLEX Trainer Test 1 Questions
Extract:
Question 1 of 5
The nurse is caring for a client with a history of spinal cord injury.
Correct Answer: C
Rationale: Keeping the bladder empty prevents distension, a common trigger for autonomic dysreflexia, a life-threatening hypertensive crisis in spinal cord injury. Blood pressure monitoring detects it, analgesics are irrelevant, and high-fiber diets prevent constipation.
Question 2 of 5
The nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD).
Correct Answer: B
Rationale: Chronic COPD causes CO2 retention, leading to a compensated respiratory acidosis with low pH (7.32), high PaCO2 (50 mmHg), and low PaO2 (70 mmHg) due to impaired gas exchange. Normal or acute values are incorrect.
Extract:
A comatose patient who is incontinent.
Question 3 of 5
The nurse should intervene if which of the following actions is noted?
Correct Answer: A
Rationale: Strategy: 'Nurse should intervene' indicates that you are looking for an incorrect action. (1) correct-contaminated gloves should be removed before answering the phone (2) correct way to roll a patient to maintain proper alignment (3) appropriate to use incontinence pad for this patient (4) appropriate position to prevent aspiration and protect the airway
Extract:
Question 4 of 5
The primary purpose for using a CPM machine for the client with a total knee repair is to help:
Correct Answer: A
Rationale: A CPM machine prevents contractures by maintaining joint mobility post-knee repair. It aids flexion but primarily prevents stiffness. Pain and lactic acid are secondary concerns.
Question 5 of 5
An adult is admitted to the emergency room with a laceration on the forearm and BP=140/74, P=110, and R=36. The client also.adult is admitted to the emergency room with a laceration on the forearm and BP=140/74, P=110, and R=36. The client also complains of tingling around the mouth and in the fingers and toes. What should the nurse expect to do initially?
Correct Answer: B
Rationale: Tachypnea and tingling suggest hyperventilation causing respiratory alkalosis; breathing into a paper bag restores CO2 levels, correcting pH.