NCLEX-RN
NCLEX RN Free Practice Questions Questions
Extract:
Question 1 of 5
The nurse teaches a pregnant client that a high-risk symptom occurring at any time during pregnancy that needs to be reported immediately to a healthcare provider is:
Correct Answer: D
Rationale: Abdominal pain may be an indication of early spontaneous abortion, preterm delivery, or a placental abruption, requiring immediate medical attention.
Question 2 of 5
A 52-year-old client who underwent an exploratory laparotomy for a bowel obstruction begins to complain of hunger on the third postoperative day. His nasogastric (NG) tube was removed this morning, and he has an IV of D5W with 0.45% normal saline running at 125 mL/hr. He asks when he can get rid of his IV and start eating. The nurse recognizes that he will be able to begin taking oral fluids and nourishment when:
Correct Answer: C
Rationale: The absence of wound infection is related to his surgical wound and not to postoperative GI functioning and return of peristalsis. Routine postoperative protocol involves detection of bowel sounds and return of peristalsis before introduction of clear liquids, followed by progression of full liquids and a regular diet versus a full regular meal first. Routine postoperative protocol for bowel obstruction is to assess for the return of bowel sounds within 72 hours after major surgery, because that is when bowel sounds normally return. If unable to detect bowel sounds, the surgeon should be notified immediately and have the client remain NPO. Routine postoperative protocol for bowel obstruction and other major surgeries involves frequent monitoring of vital signs in the immediate postoperative period (in recovery room) and then every 4 hours, or more frequently if the client is unstable, on the nursing unit. This includes assessing for signs of hypovolemic shock. Vital signs usually stabilize within the first 24 hours postoperatively.
Question 3 of 5
A male client had a right below-the-knee amputation 4 days ago. His incision is healing well. He has gotten out of bed several times and sat at the side of the bed. Each time after returning to bed, he has experienced pain as if it were located in his right foot. Which nursing measure indicates the nurse has a thorough understanding of phantom pain and its management?
Correct Answer: B
Rationale: This statement is entirely false. Phantom pain may be caused by nerves continuing to carry sensation to the brain even though the limb is removed. It is real, intense, and should be treated as ordinary pain would. Although the cause of phantom pain is still unknown, these measures may promote the relief of any type of pain, not just phantom pain. Phantom pain is not caused by trauma, spasms, and edema and will not be relieved by decreasing edema.
Question 4 of 5
A female client has been treated since childhood for mitral valve prolapse. The antibiotic of choice for her during pregnancy would be:
Correct Answer: D
Rationale: Sulfa is a teratogen and will cause kernicterus. Tetracycline is a teratogen and will affect tooth development. Hydralazine is not an antibiotic but a calcium channel blocker. Erythromycin is safe during pregnancy and can be used when the client is allergic to penicillin.
Question 5 of 5
The clinic nurse is teaching a co-worker regarding medication administration. The nurse is aware that which of the following medications are category X medications and should not be taken by the client during pregnancy?
Correct Answer: A, B
Rationale: Category X medications, like minocycline (
A) and tazarotene (Tazorac,
B), are contraindicated in pregnancy due to fetal harm. Calcipotriene (Devonex,
C), levothyroxine (
D), and cefazolin (E) are safer (categories B or
C).