NCLEX-RN
NCLEX Practice Test RN Questions
Extract:
Question 1 of 5
While changing the dressing on a client's central line, the nurse notices redness and warmth at the needle insertion site. Which of the following actions would be appropriate to implement based on this finding?
Correct Answer: C
Rationale: The nurse should always document findings and alert the physician to the findings as well. The physician may then initiate a new central line and order the current central line to be discontinued.
Question 2 of 5
A client with cervical cancer has a radioactive implant. Which statement indicates that the client understands the nurse's teaching regarding radioactive implants?
Correct Answer: C
Rationale: Clients with radioactive implants can use the bedside commode if permitted, indicating understanding of mobility restrictions. Visitor limitations, catheters, and side effects depend on the specific protocol.
Question 3 of 5
The nurse is caring for a client in labor. The fetal monitor shows early decelerations. The nurse should:
Correct Answer: C
Rationale: Early decelerations are benign caused by fetal head compression during contractions and do not indicate fetal distress. Continuing to monitor the fetal heart rate is appropriate. Repositioning oxygen or notifying the physician are unnecessary unless other abnormalities occur.
Question 4 of 5
Which toys are suited to the developmental skills of the 2-3 year old?
Correct Answer: A, C, E
Rationale: For 2-3-year-olds, soap bubbles (
A), riding toys (
C), and talking toys (E) match gross motor and imaginative play skills. Skates (
B) and bicycles (
D) require advanced coordination.
Question 5 of 5
An appropriate nursing intervention for the client with borderline personality disorder is:
Correct Answer: A
Rationale: Clients with borderline personality disorder often experience mood instability and are at risk for self-harm or suicide. Observing for signs of depression or suicidal thinking is a priority nursing intervention to ensure safety. Allowing the client to lead group sessions or select a caregiver may reinforce manipulative behaviors, and restricting activity to the unit is not typically therapeutic unless specified for safety.