NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
The nurse is caring for a client with an endemic goiter. The nurse recognizes that the client's condition is related to:
Correct Answer: A
Rationale: Endemic goiter results from iodine deficiency, often in areas with iodine-depleted soil, leading to insufficient thyroid hormone production.
Question 2 of 5
A female client admitted to the labor and delivery unit thinks her bag of water 'broke' approximately 2 hours ago. She is having mild contractions 5 minutes apart. The most immediate nursing intervention would be to:
Correct Answer: B
Rationale: Amniotic fluid is generally pale and straw colored. Meconium-stained amniotic fluid would indicate a previous hypoxic episode. This intervention, though appropriate, is not the immediate priority. With rupture of the membranes, the umbilical cord may prolapse if the presenting part does not fill the pelvis. Assessing FHR ascertains fetal well-being. More information regarding fetal status and assessing for membrane rupture is needed prior to contacting the physician. Nitrazine test paper differentiates amniotic fluid from urine. Amniotic fluid is normally alkaline in contrast to urine, which is acidic. This intervention, though appropriate, is not the immediate priority.
Question 3 of 5
The nurse is providing discharge teaching for a client taking naltrexone (Revia). The nurse should instruct the client to avoid which over-the-counter medication:
Correct Answer: C
Rationale: Naltrexone, used for opioid or alcohol dependence, can interact with cold medicines containing dextromethorphan, which may have opioid-like effects, reducing naltrexone’s efficacy. Acetaminophen, ibuprofen, and antihistamines do not have significant interactions.
Question 4 of 5
The nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD). The nurse should give priority to:
Correct Answer: A
Rationale: COPD impairs gas exchange, so monitoring oxygen saturation is critical to assess respiratory function and guide oxygen therapy.
Question 5 of 5
The nurse is caring for a client who is receiving oxytocin for labor induction. The fetal heart rate shows variable decelerations. The nurse’s first action should be to:
Correct Answer: B
Rationale: Variable decelerations suggest umbilical cord compression. Repositioning the client (e.g. to the left side or knee-chest position) may relieve compression and is the first action. Stopping oxytocin or notifying the physician may be needed if repositioning is ineffective.