NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
The nurse is teaching a client with a new colostomy about appliance care. Which instruction should be included?
Correct Answer: B
Rationale: Emptying the colostomy pouch when one-third to one-half full prevents leakage and skin irritation. Changing every 12 hours is excessive, soap may leave residue, and lotion can interfere with adhesion.
Question 2 of 5
The nurse is teaching the mother of an infant with galactosemia. Which information should be included in the nurse's teaching?
Correct Answer: A
Rationale: Galactosemia requires a lactose-free diet, as galactose is harmful. Checking labels for lactose is critical. Galactose cannot be added, siblings may be affected, and galactose is not essential.
Question 3 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.
Question 4 of 5
A client with diabetes asks the nurse for advice regarding methods of birth control. Which method of birth control is most suitable for the client with diabetes?
Correct Answer: A
Rationale: An intrauterine device (IU
D) is safe and effective for women with diabetes as it does not affect glucose metabolism. Oral contraceptives may worsen glycemic control and diaphragms/sponges require spermicides that increase infection risk in diabetics.
Question 5 of 5
At her monthly prenatal visit, a client reports experiencing heartburn. Which nursing measure should be included in her plan of care to help alleviate it?
Correct Answer: C
Rationale: At least eight glasses of fluid per day are encouraged to help dilute stomach contents, thereby decreasing irritation. Alka Seltzer contains aspirin, which is irritating to gastric mucosa, and therefore should be avoided. Small, frequent bland meals help to decrease gastric pressure and to prevent reflux. Lying down after meals may cause gastric reflux and prevents optimal gastric emptying.