NCLEX-RN
NCLEX RN Practice Questions Questions
Extract:
Question 1 of 5
The nurse is preparing an adult male for a transurethral resection of the prostate (TURP). Which statement by the client indicates a need for further teaching by the nurse?
Correct Answer: C
Rationale: TURP is performed transurethrally, so no external incision or dressing is needed. Other statements are correct.
Question 2 of 5
A client is scheduled for hemodialysis twice weekly through an arteriovenous fistula in the left arm. Following each hemodialysis treatment, the nurse should evaluate the client for which of the following because of risks associated with hemodialysis? Select all that apply.
Correct Answer: A,C
Rationale: Hemodialysis risks include fluid volume deficit (
A) from rapid fluid removal and bleeding (
C) from the fistula site. Fluid excess (
B) and pulmonary edema (E) are pre-dialysis risks, and acidosis (
D) is corrected by dialysis.
Question 3 of 5
A client with a T6 injury 6 months ago develops facial flushing and a BP of 210/106. After elevating the head of the bed, which is the most appropriate nursing action?
Correct Answer: B
Rationale: The symptoms suggest autonomic dysreflexia, often triggered by a distended bladder in spinal cord injury patients. Assessing and relieving the bladder is the priority after elevating the bed.
Question 4 of 5
The nurse is monitoring a client following a lung resection. The hourly output from the chest tube was 300 mL. The nurse should give priority to:
Correct Answer: D
Rationale: A chest tube output of 300 mL per hour is excessive and may indicate hemorrhage, requiring immediate physician notification.
Question 5 of 5
The client who is 2 weeks post-burn with a 40% deep partial-thickness injury still has open wounds. The nurse's assessment reveals the following findings: temperature 96.5°F, BP 87/40, and severe diarrhea stools. What problem does the nurse most likely suspect?
Correct Answer: C
Rationale: Hypothermia, hypotension, and diarrhea suggest systemic gram-negative infection, likely sepsis, due to bacterial translocation from open wounds or the gut in a burn patient.