NCLEX Questions, NCLEX Trainer Test 10 Questions, NCLEX-PN Questions, Nurselytic

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Question 1 of 5

The nurse is performing an ice massage for a client in chronic pain. The nurse is MOST concerned if which of the following is observed?

Correct Answer: B

Rationale: Mottling or graying indicates potential frostbite or tissue damage, a serious concern requiring immediate cessation of ice massage. Options A, C, and D are less critical: redness is common, burning/tingling suggests ischemia, and numbness/cold is expected.

Question 2 of 5

A client reports that he has been vomiting for three days, has a low-grade temperature, and feels lethargic. Which Ivanof the following nursing actions is MOST appropriate in evaluating for fluid volume deficit?

Correct Answer: B

Rationale: daily weight is the best way to evaluate for fluid volume deficit

Question 3 of 5

The nurse is caring for a toddler in traction, and the toddler is receiving chloral hydrate (Noctec). The toddler becomes irritable and extremely restless. Which nursing action is MOST appropriate?

Correct Answer: B

Rationale: Irritability and restlessness suggest a paradoxical reaction to chloral hydrate, requiring physician notification for medication adjustment. Options A, C, and D are unsafe or ineffective.

Question 4 of 5

The nurse is preparing to administer insulin to a client with type I diabetes.

Correct Answer: B

Rationale: Checking the client’s blood glucose level is the first step to ensure the insulin dose is appropriate, preventing hypo- or hyperglycemia. Verifying the dose, cleansing the site, and rotating sites are important but follow glucose confirmation.

Question 5 of 5

A teenager comes to the clinic complaining of fatigue, a sore throat, and flu-like symptoms for the previous two weeks. Physical exam reveals enlarged lymph nodes and temperature of 100.3°F (37.9°C). Which of the following statements by the nurse is BEST?

Correct Answer: C

Rationale: symptoms indicate mononucleosis, spread by direct contact; advise family to avoid contact with cups and silverware for about 3 months

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