NCLEX-RN
NCLEX RN Practice Questions Free Questions
Extract:
Question 1 of 5
The nurse is performing an assessment on a client with a history of a tension pneumothorax. Which finding is most concerning?
Correct Answer: A
Rationale: Tracheal deviation in a tension pneumothorax indicates mediastinal shift from increased intrathoracic pressure, a life-threatening emergency requiring immediate attention.
Question 2 of 5
Which of the following nursing care goals has the highest priority for a child with epiglottitis?
Correct Answer: A
Rationale: Of these four goals, maintenance of a calm, quiet atmosphere to reduce anxiety and to allow for rest is the most important. Although nutrition is important, the child needs fluids to maintain fluid and electrolyte balance more than solid foods. In addition, the child may not be able to swallow solid foods owing to epiglottic swelling. This goal is unrealistic because fever is a common symptom of the infection associated with epiglottitis. If overexerted, the child will need more O2 and energy than available, and these requirements may exacerbate the condition.
Question 3 of 5
The rationale for inserting a French catheter every hour for the client with epidural anesthesia is:
Correct Answer: C
Rationale: Epidural anesthesia can diminish bladder sensation leading to urinary retention. Hourly catheterization prevents bladder distention and complications. The other reasons are not accurate or relevant to epidural effects.
Question 4 of 5
A client is admitted with disseminated herpes zoster (shingles). According to the Centers for Disease Control Guidelines for Infection Control:
Correct Answer: A
Rationale: Disseminated herpes zoster requires airborne precautions because the varicella-zoster virus can spread through respiratory droplets in immunocompromised patients.
Question 5 of 5
A client with a history of Crohn's disease is admitted with a small bowel obstruction. The nurse should give priority to:
Correct Answer: A
Rationale: Small bowel obstruction in Crohn's disease can cause fluid loss through vomiting or sequestration, making monitoring for dehydration the priority to prevent hypovolemia.