NCLEX-RN
NCLEX RN Practice Questions with Answers Questions
Extract:
Question 1 of 5
The nurse is caring for a client with a tracheostomy. Which of the following interventions should be included in the plan of care? Select all that apply.
Correct Answer: A, B, C, D
Rationale: Suctioning, cleaning the cannula, changing ties, and monitoring for skin breakdown are essential for tracheostomy care. Cuffed tubes are used in specific cases.
Question 2 of 5
The nurse is caring for a client with a diagnosis of Parkinson's disease who is taking benztropine mesylate daily. When assessing the client, what should the nurse specifically monitor for to determine if the client is experiencing a side effect of this medication?
Correct Answer: D
Rationale: Urinary retention is a side effect of benztropine mesylate, an anticholinergic medication. The nurse needs to observe for dysuria, distended abdomen, voiding in small amounts, and overflow incontinence. The remaining options do not relate to this medication.
Question 3 of 5
A client with a diagnosis of multiple sclerosis is prescribed baclofen (Lioresal). The nurse should monitor the client for which of the following side effects?
Correct Answer: B
Rationale: Baclofen, a muscle relaxant, commonly causes drowsiness, which the nurse should monitor in clients with multiple sclerosis.
Question 4 of 5
A 10-day postpartum breast-feeding client telephones the postpartum unit reporting a reddened, painful breast and elevated temperature. Based on assessment of the client's complaints, which action should the nurse tell the client to do?
Correct Answer: C
Rationale: Based on the signs and symptoms presented by the client (particularly the elevated temperature), the primary health care provider needs to be notified because an antibiotic that is tolerated by the infant, as well as the mother, may be prescribed. The mother should continue to nurse on both breasts, but should start the infant on the unaffected breast while the affected breast lets down.
Question 5 of 5
The nurse is teaching a client with hypertension about lifestyle modifications. Which of the following recommendations is most effective in reducing blood pressure?
Correct Answer: B
Rationale: Reducing sodium intake is highly effective in lowering blood pressure by decreasing fluid retention and vascular resistance.