NCLEX-RN
NCLEX RN Practice Test Free Questions
Extract:
Question 1 of 5
When assessing the urinary output of a client who has had extracorporeal lithotripsy, the nurse can expect to find:
Correct Answer: A
Rationale: Extracorporeal lithotripsy breaks up kidney stones, leading to cherry-red urine from minor bleeding that clears as healing progresses.
Question 2 of 5
The nurse plans on administering a medication using the Z-track intramuscular technique. The nurse knows the following steps are required during the procedure. Select all that apply.
Correct Answer: A,C
Rationale: Z-track requires an air lock (
A) to seal medication and a new needle (
C) to prevent tracking. The needle is inserted at 90 degrees, not 45 (
D), and various muscles can be used (B is not mandatory).
Question 3 of 5
Which laboratory test is used to identify injury to the myocardium and can remain elevated for up to 3 weeks?
Correct Answer: D
Rationale: Troponin T or I is highly specific for myocardial injury and can remain elevated for up to 2-3 weeks, making it the best marker for detecting cardiac damage.
Question 4 of 5
The nurse is caring for a client with scalding burns across the face, neck, upper half of the anterior chest, and entire right arm. Using the rule of nines, estimate the percentage of body burned.
Correct Answer: B
Rationale: Rule of nines: face/neck (4.5% head anterior), upper half anterior chest (4.5% anterior torso/2 = 2.25%), right arm (9%) = 4.5 + 2.25 + 9 = 23%.
Question 5 of 5
The nurse is caring for an organ donor client with a severe head injury from an MVA. Which of the following is most important when caring for the organ donor client?
Correct Answer: A
Rationale: Maintaining BP at 90 mmHg or greater ensures organ perfusion, critical for organ viability in a donor. Normal temperature and adequate urine output are important, but BP is the priority. Low hematocrit is not a goal.