NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
When assessing the client's blood pressure, the nurse should use a cuff with a width that is __% of the circumference of the extremity. (Fill in the blank.)
Correct Answer: 40
Rationale: The blood pressure cuff width should be approximately 40% of the extremity’s circumference to ensure accurate readings. A cuff too narrow or wide can falsely elevate or lower readings.
Question 2 of 5
The nurse is assigning staff to care for a number of clients with emotional disorders. Which facet of care is suitable to the skills of the nursing assistant?
Correct Answer: B
Rationale: Providing routine catheter care is within the scope of a nursing assistant, as it involves basic hygiene tasks, unlike the other options, which require advanced assessment or monitoring.
Question 3 of 5
When the nurse checks the fundus of a client on the first postpartum day,she notes that the fundus is firm level with the umbilicus and displaced to the side. The next action the nurse should take is to:
Correct Answer: A
Rationale: A displaced fundus on the first postpartum day is often due to bladder distention which pushes the uterus aside. Checking for bladder distention (e.g. by palpation or encouraging voiding) is the next step to correct the displacement.
Question 4 of 5
A woman diagnosed with multiple sclerosis is disturbed with diplopia. The nurse will teach her to:
Correct Answer: D
Rationale: Limiting activities requiring close vision will not alleviate the discomfort of double vision. Frequent naps may be comforting, but they will not prevent double vision. Artificial tears are necessary in the absence of a corneal reflex, but they have no effect on diplopia. An eye patch over either eye will eliminate the effects of double vision during the time the eye patch is worn. An eye patch is safe for a person with an intact corneal reflex.
Question 5 of 5
A 48-year-old male client is hospitalized with mild ascites, bruising, and jaundice. He has a 20-year history of alcohol abuse. The client is diagnosed with cirrhosis. His serum ammonia level is high, indicating hepatic encephalopathy. He has esophageal varices. Which of the following may cause the varices to rupture?
Correct Answer: A
Rationale: Lifting heavy objects will increase intrathoracic pressure, thus placing the client at risk for rupturing esophageal varices.