NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
The nurse is caring for a client with a nasogastric tube for decompression. Which action is most appropriate to ensure proper function?
Correct Answer: C
Rationale: Checking nasogastric tube placement (e.g., via pH or aspiration) before feedings or medications ensures the tube is in the stomach, preventing aspiration. Irrigation frequency depends on protocol, clamping may cause reflux, and supine positioning risks aspiration.
Question 2 of 5
The primary reason that an increase in heart rate (100 bpm) detrimental to the client with a myocardial infarction (MI) is that:
Correct Answer: D
Rationale: Decreased stroke volume and blood pressure will occur secondary to decreased diastolic filling. Tachycardia primarily decreases diastole; systolic time changes very little. Contractility decreases owing to the decreased filling time and decreased time for fiber lengthening. Decreased O2 supply due to decreased time for filling of the coronary arteries increases ischemia and infarct size. Tachycardia primarily robs the heart of diastolic time, which is the primary time for coronary artery filling.
Question 3 of 5
A 20-year-old client presents to the obstetrics-gynecology clinic for the first time. She tells the nurse that she is pregnant and wants to start prenatal care. After collecting some initial assessment data, the nurse measures her fundal height to be at the level of the umbilicus. The nurse estimates the fetal gestational age to be approximately:
Correct Answer: C
Rationale: At 10 weeks, the fundus is located slightly above the symphysis pubis. At 16 weeks, the fundus is halfway between the symphysis pubis and the umbilicus. At 20 weeks, the fundus is located approximately at the umbilicus. At 30 weeks, the fundal height is about 30 cm, or 10 cm above the umbilicus.
Question 4 of 5
Children often experience visual impairments. Refractive errors affect the child's visual activity. The main refractive error seen in children is myopia. The nurse explains to the child's parents that myopia may also be described as:
Correct Answer: C
Rationale: Cataracts are not considered refractive errors. Cataracts can be described as opacity of the lens. Hyperopia is the term for farsightedness. One can see objects at a distance more clearly than close objects. Myopia is the term for nearsightedness. Objects that are close in distance are more clearly seen. Lazy eye refers to strabismus or misalignment of the eyes.
Question 5 of 5
The physician has ordered a lumbar puncture for a client with suspected Guillain-Barre syndrome. The spinal fluid of a client with Guillain-Barre syndrome typically shows:
Correct Answer: B
Rationale: Guillain-Barre syndrome is characterized by elevated protein levels in cerebrospinal fluid with a normal cell count, reflecting nerve root inflammation.