NCLEX-RN
NCLEX RN Practice Exam Questions
Extract:
Question 1 of 5
The nursing assistant is taking vitals for a client on mechanical ventilation. Which of the following findings should the nursing assistant report to the nurse immediately?
Correct Answer: D
Rationale: Fever (102.1°F) in a ventilated client suggests infection (e.g., ventilator-associated pneumonia), requiring immediate reporting.
Question 2 of 5
A 25-year-old male is brought to the emergency room with a piece of metal in his eye. The first action the nurse should take is:
Correct Answer: C
Rationale: Covering both eyes prevents eye movement, reducing further damage.
Question 3 of 5
Which observation in the newborn of a diabetic mother would require immediate nursing intervention?
Correct Answer: C
Rationale: Jitteriness in a newborn of a diabetic mother may indicate hypoglycemia, which requires immediate nursing intervention to prevent complications.
Question 4 of 5
A client has a diagnosis of discoid lupus erythematosus (DLE). The nurse recognizes that discoid lupus differs from systemic lupus erythematosus because it:
Correct Answer: B
Rationale: Discoid lupus erythematosus primarily affects the skin, causing chronic rashes, unlike systemic lupus, which can involve multiple organs.
Question 5 of 5
The nurse is working with a client in the psychiatric unit. The client has memory gaps, which she fills in with detailed fantasies that she believes to be true. The nurse understands that the client is exhibiting which type of abnormal thought process?
Correct Answer: B
Rationale: Confabulation involves filling memory gaps with fabricated details believed to be true, common in certain psychiatric or neurological conditions.