NCLEX-PN
NCLEX Trainer Test 1 Questions
Extract:
Question 1 of 5
The parents of a one-month-old boy bring their son to the clinic for evaluation of a possible right dislocated hip.
Correct Answer: B
Rationale: Unilateral hip dislocation causes uneven gluteal folds and thigh creases, with deeper and longer folds on the affected side due to hip displacement. Limited abduction (not adduction), shortened limb length, and variable rotation are more typical findings.
Question 2 of 5
An extremely agitated client is receiving haloperidol (Haldol) IM every 30 minutes while in the psychiatric emergency room.
Correct Answer: A
Rationale: Haloperidol can cause postural hypotension due to alpha-adrenergic blockade, especially during rapid neuroleptization. Monitoring vital signs, particularly blood pressure, every 30 minutes ensures client safety. Reassurance, education, and monitoring side effects are secondary to physiological stability.
Question 3 of 5
Which assessment is most essential before administering digoxin to an adult?
Correct Answer: B
Rationale: Taking an apical pulse ensures the heart rate is above 60 bpm, as digoxin can cause bradycardia, a critical safety check.
Question 4 of 5
The nurse is teaching a client with a new diagnosis of atrial fibrillation about diltiazem (Cardizem). Which of the following instructions should the nurse include?
Correct Answer: B
Rationale: Swelling in the legs may indicate heart failure, requiring reporting. Options A, C, and D are incorrect.
Extract:
A client with paralysis from a cerebrovascular accident (CVA).
Question 5 of 5
Which of the following is a priority nursing goal in the plan of care for a client with paralysis from a cerebrovascular accident (CVA)?
Correct Answer: B
Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) to prevent deformities, the nurse needs to prevent adduction of the affected shoulder (2) correct-flexor muscles are stronger than extensor muscles (3) client will be unable to perform active ROM, will need assistance from nurse (4) to prevent deformities, the nurse needs to prevent external rotation of the hip joint, prevent foot drop (plantar flexion), and place the hand in slight supination so that the fingers are barely flexed