NCLEX-RN
NCLEX RN Practice Questions with Answers Questions
Extract:
Question 1 of 5
Which of the following should the nurse identify as a priority nursing diagnosis for an infant with intussusception?
Correct Answer: C
Rationale: Acute pain is the priority nursing diagnosis for an infant with intussusception due to bowel obstruction causing severe abdominal pain. Fluid volume and gas exchange may be concerns but are secondary.
Question 2 of 5
A 10-year-old child has the following blood glucose readings during a 24-hour period. Which reading requires the most immediate intervention?
Correct Answer: A
Rationale: A blood glucose of 50 mg/dL indicates hypoglycemia, requiring immediate intervention to prevent neurological complications.
Question 3 of 5
A client with a chronic mental illness who does not always take her medications is separated from her husband and receives Supplemental Security Income. She lives with her mother and older sister and manages her own medication. The client's mother is in poor health and receives Social Security benefits. The client's sister works outside the home, and the client's father is dead. Which of the following issues should the nurse need to address first?
Correct Answer: D
Rationale: Medication non-adherence in a client with chronic mental illness is the priority issue, as it directly impacts mental stability and safety. Family, marital, and financial issues are secondary.
Question 4 of 5
The home care nurse is doing an assessment interview with an older adult client who asks the nurse to buy some groceries for her because she is not feeling well today. Which statement should the nurse use in response?
Correct Answer: B
Rationale: The nurse's duty is to help the client; but in helping the client, the nurse's first action is to finish the assessment and then find immediate and long-term solutions to the problem. In options 1 and 3 the nurse asks a closed-ended question, which is unlikely to further nurse-client communication. Option 4 is inappropriate while failing to address the client's problem.
Question 5 of 5
A client with a history of chronic lymphocytic leukemia is prescribed rituximab (Rituxan). The nurse should monitor the client for which of the following side effects during infusion?
Correct Answer: C
Rationale: Rituximab can cause infusion reactions, such as fever or chills, requiring close monitoring during administration.