NCLEX-RN
NCLEX RN Practice Exam Questions
Extract:
Question 1 of 5
The nurse is caring for the patient following removal of a large posterior oral lesion. The priority nursing measure would be to:
Correct Answer: A
Rationale: Maintaining a patent airway is critical post-oral surgery due to the risk of swelling or bleeding obstructing the airway.
Question 2 of 5
Each staff person has an individual password that allows access to electronic health records. Under which of the following circumstances should a nurse allow another staff person to use his/her password?
Correct Answer: D
Rationale: Passwords must not be shared (
D) to protect patient confidentiality and comply with HIPAA. Sharing with a physician (
A), nurse (
B), or supervisor (
C) is unauthorized.
Question 3 of 5
The nurse caring for a client with chest tubes notes that the Pleuravac's collection chambers are full. The nurse should:
Correct Answer: D
Rationale: When the Pleuravac collection chambers are full, a new unit is needed to continue effective drainage and maintain the closed system.
Question 4 of 5
The nurse is teaching feeding protocol to the spouse of a client who experienced a severe stroke. Which statement by the spouse indicates a need for further explanation by the nurse?
Correct Answer: B
Rationale: Turning on the television during meals can distract the client, increasing the risk of aspiration, and requires further teaching. Other statements are appropriate.
Question 5 of 5
The nurse is making initial rounds on a client with a C5 fracture. The client is in a halo vest and is receiving O2 at 40% via mask to a tracheostomy. Assessment reveals a respiratory rate of 40 and O2 saturation of 88. The client is restless. Which initial nursing action is most indicated?
Correct Answer: B
Rationale: Restlessness, tachypnea, and low O2 saturation suggest airway obstruction or secretions. Tracheal suctioning is the initial action to clear the airway and improve oxygenation.