NCLEX-RN
NCLEX RN Practice Test Questions
Extract:
Question 1 of 5
When the nurse checks the fundus of a client on the first postpartum day, she notes that the fundus is firm, is at the level of the umbilicus, and is displaced to the right. The next action the nurse should take is to:
Correct Answer: A
Rationale: A fundus displaced to the right on the first postpartum day is often due to bladder distention, which should be assessed next.
Question 2 of 5
The nurse is caring for a client after a laryngectomy. The client is anxious, with a respiratory rate of 32 and an oxygen saturation of 88. The nurse's first action should be to:
Correct Answer: B
Rationale: Low oxygen saturation (88%) and high respiratory rate indicate hypoxemia. Increasing oxygen flow rate is the fastest way to improve oxygenation. Suctioning may be needed later, but oxygen is the priority.
Question 3 of 5
An infant's Apgar score is 9 at 5 minutes. The most likely cause for the deduction of one point is:
Correct Answer: C
Rationale: Blue hands and feet (acrocyanosis) are common in newborns and likely cause a 1-point deduction in the appearance category of the Apgar score.
Question 4 of 5
A 6-month-old is being treated for thrush with Nystatin (mycostatin) oral suspension. The nurse should administer the medication by:
Correct Answer: B
Rationale: Nystatin for thrush should be applied directly to the oral mucosa using a cotton-tipped swab to ensure effective treatment.
Question 5 of 5
The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention?
Correct Answer: B
Rationale: Adding baby oil to bath water moisturizes the skin, reducing pruritis in hepatitis clients, unlike warm showers or powder, which may worsen dryness.