NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
The nurse is ready to begin an exam on a nine-month-old infant who is sitting quietly on his mother's lap. Which should the nurse do first?
Correct Answer: B
Rationale: When examining an infant, the nurse should start with the least invasive procedures to maintain the infant’s calm state. Listening to heart and lung sounds is non-invasive and can be done while the infant is quiet. Checking the Babinski reflex, palpating the abdomen, or checking tympanic membranes may cause discomfort and disrupt the exam.
Question 2 of 5
An adult client is admitted to the orthopedic unit with a history of thalassemia. What clinical manifestations does the nurse expect the client to exhibit?
Correct Answer: A, B, C
Rationale: Thalassemia causes splenomegaly (
A) from hemolysis, mild anemia (
B), and jaundice (
C) from bilirubin buildup. Headaches (
D) and epistaxis (E) are less common.
Question 3 of 5
The nurse is caring for a child with a diagnosis of possible hydrocephalus. Which assessment data on the admission history would be the most objective?
Correct Answer: C
Rationale: Head measurement (e.g., head circumference) is the most objective for hydrocephalus, directly assessing skull enlargement. Anorexia (
A), vomiting (
B), and temperature (
D) are subjective or less specific.
Question 4 of 5
Which of the following combinations of foods is appropriate for an eight-month-old infant?
Correct Answer: C
Rationale: Rice cereal, bananas, and strained carrots are developmentally appropriate, easily digestible foods for an eight-month-old, unlike the other options, which include choking hazards or inappropriate items like whole milk.
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.