NCLEX-RN
NCLEX RN Practice Questions Free Questions
Extract:
Question 1 of 5
Which newborn assessment is considered an abnormal finding that requires immediate attention?
Correct Answer: C
Rationale: Jitteriness and shaking in a newborn may indicate hypoglycemia seizures or neurological issues requiring immediate attention. Cyanosis of hands and feet (acrocyanosis) three umbilical vessels and harlequin sign are normal or benign findings.
Question 2 of 5
The nurse is assessing a client with suspected deep vein thrombosis (DVT). Which finding is most indicative?
Correct Answer: B
Rationale: A warm, red, swollen calf is a classic sign of DVT due to clot-related inflammation. Bilateral edema (
A) suggests heart failure, cramping (
C) is nonspecific, and pale/cool foot (
D) indicates arterial occlusion.
Question 3 of 5
A client delivered a term infant 1 hour ago. Her uterus on assessment is boggy and is U+1 in contrast to the previous assessment of U-2. The immediate nursing response is to:
Correct Answer: D
Rationale: Methergine is given following placental delivery to promote uterine contractions and prevent hemorrhage. Methergine may be administered in this clinical situation, but fundal massage would be the first response. Removal of retained placental fragments is done by the physician and is not the first response. If the fundus rises and is deviated, particularly to the right, the nurse should suspect bladder distention secondary to bladder and urethral trauma associated with birth and decreased bladder tone following delivery.
Therefore, women have a diminished sensation to void. A boggy fundus rises and is indicative of blood pooling, predisposing the woman to clot formation. Massage the uterus until firm.
Too vigorous massage will result in atonia. Clots may be expelled by a kneading motion of the uterus by the nurse.
Question 4 of 5
The physician has ordered aerosol treatments, chest percussion, and postural drainage for a client with cystic fibrosis. The nurse recognizes that the combination of therapies is to:
Correct Answer: C
Rationale: These therapies aim to dilate airways (aerosols), mobilize mucus (percussion), and clear secretions (postural drainage) to improve breathing in cystic fibrosis.
Question 5 of 5
A client was prescribed a major tranquilizer 2 months ago. One month ago she was placed on benztropine (Cogentin). What would indicate that benztropine therapy is effective?
Correct Answer: A
Rationale: Benztropine alleviates extrapyramidal side effects of tranquilizers, such as tremors and rigidity, resulting in smooth, coordinated movements.