NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
Your client had a ruptured appendix and peritonitis. What type of healing would be most likely for this client?
Correct Answer: A
Rationale: A ruptured appendix with peritonitis typically results in a wound that heals by secondary intention, where the wound is left open to heal from the base up due to infection.
Question 2 of 5
The primary purpose of root cause analysis is to:
Correct Answer: A
Rationale: Root cause analysis aims to identify underlying process flaws that contributed to an adverse event to prevent recurrence, rather than focusing on individual blame .
Question 3 of 5
The nurse is assessing a client with a suspected tension pneumothorax. Which of the following findings is most indicative of this condition?
Correct Answer: B
Rationale: Jugular vein distension is a sign of tension pneumothorax due to increased intrathoracic pressure compressing the vena cava.
Question 4 of 5
A client with a diagnosis of diverticulitis is prescribed a high-fiber diet. Which of the following foods should the nurse recommend?
Correct Answer: B
Rationale: Broccoli is high in fiber, supporting bowel regularity in diverticulitis, unlike low-fiber foods like white rice or bread.
Question 5 of 5
The nurse is monitoring for the presence of pitting edema in the prenatal client. The nurse presses the fingertips of the middle and index fingers against the shin in 4 different locations and holds pressure for 2 to 3 seconds. The nurse notes that the indentation is approximately 1-inch deep. The nurse should document that the client has which level of pitting edema?
Correct Answer: D
Rationale: When evaluating the presence of pitting edema, the nurse presses the fingertips of the index and middle fingers against the shin and holds pressure for 2 to 3 seconds. An indentation approximately 1-inch deep would be indicative of +4 edema. A slight indentation would indicate +1 edema. An indentation approximately 1/4-inch deep indicates +2 edema. An indentation approximately 1/2-inch deep indicates +3 edema.