NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
The nurse is teaching a client with a history of allergic rhinitis about self-care. The nurse should tell the client to:
Correct Answer: A
Rationale: Avoiding allergens reduces symptoms in allergic rhinitis, such as sneezing and nasal congestion.
Question 2 of 5
A client diagnosed with severe anemia is to receive 2 U of packed red blood cells. Prior to starting the blood transfusion, the nurse must:
Correct Answer: A
Rationale: A baseline set of vital signs is necessary to determine if any transfusion reactions occur as the blood product is being administered. The only companion fluid to be used during a blood transfusion is normal saline. The calcium in Ringer's lactate can cause clotting. Only a blood administration set should be used. A microdrip tube would cause lysis of the red blood cells. Proper identification of the recipient and the blood product must be validated by at least two people.
Question 3 of 5
The primary reason that an increase in heart rate (100 bpm) detrimental to the client with a myocardial infarction (MI) is that:
Correct Answer: D
Rationale: Decreased stroke volume and blood pressure will occur secondary to decreased diastolic filling. Tachycardia primarily decreases diastole; systolic time changes very little. Contractility decreases owing to the decreased filling time and decreased time for fiber lengthening. Decreased O2 supply due to decreased time for filling of the coronary arteries increases ischemia and infarct size. Tachycardia primarily robs the heart of diastolic time, which is the primary time for coronary artery filling.
Question 4 of 5
The nurse reviewing the lab results of a client receiving Cytoxan (cyclophosphamide) for Hodgkin's lymphoma finds the following: WBC 4,200, RBC 3,800,000, platelets 25,000, and serum creatinine 1.0 mg. The nurse recognizes that the greatest risk for the client at this time is:
Correct Answer: B
Rationale: A platelet count of 25,000 indicates severe thrombocytopenia, posing a significant risk of bleeding, which is the greatest immediate concern compared to infection, anemia, or renal failure.
Question 5 of 5
A client's admission history reveals complaints of fatigue, chronic sore throat, and enlarged lymph nodes in the axilla and neck.
Correct Answer: A
Rationale: A complete blood count (CB
C) detects abnormal white blood cell counts, supporting a leukemia diagnosis. Chest x-ray (
B), bone marrow aspiration (
C), and CT scan (
D) are confirmatory but not initial tests.