NCLEX Trainer Test 10 Questions

Question 1 of 5

A 19-year-old college student has a Mantoux test performed at the college health clinic. The result is positive. The clinic nurse should

A. refer the student to an appropriate center for further testing.B. restrict the student's activity until his parents can be notified.C. notify the local Public Health Department.D. place the student in an isolation room in the college infirmary.

Correct Answer: A

Rationale: will perform chest x-ray

Question 2 of 5

The nurse is caring for a client with deep vein thrombosis (thrombophlebitis) of the left leg. Which of the following would be an appropriate nursing goal for this client?

A. Decrease inflammatory response in the affected extremity and prevent embolus formation.B. Increase peripheral circulation and oxygenation of the affected extremity.C. Prepare the client and family for anticipated vascular surgery on the affected extremity.D. Prevent hypoxia associated with the development of a pulmonary embolus.

Correct Answer: A

Rationale: important to prevent the complication of pulmonary embolism in clients at high risk

Question 3 of 5

An intravenous pyelogram (IVP) is ordered for a client who is scheduled to have his left kidney removed because of hypertension and renal disease. Which of the following nursing actions has the highest priority the evening prior to the IVP?

A. Administer a cathartic enema to cleanse the bowel.B. Obtain information about client allergies.C. Instruct the client to be NPO after midnight.D. Teach the client that x-rays will be taken at multiple intervals.

Correct Answer: B

Rationale: assessment, clients sensitive to iodine can develop anaphylaxis; client should be asked specifically about allergies to iodine; iodine is present in the radiopaque material that is injected IV

Extract:

An elderly client receiving IV fluids of 0.9% NaCl at 125 cc/h into her left arm. During a routine assessment, the nurse finds that the client has distended neck veins, shortness of breath, and crackles in both lung bases.

Question 4 of 5

The nurse should

A. decrease the IV rate to 20 cc/h and notify the physician.B. decrease the IV rate to 100 cc/h and continue to monitor the client.C. discontinue the IV and start oxygen at 6 L/min.D. assess for infiltration of the IV solution.

Correct Answer: A

Rationale: Strategy: Answers are a mix of assessments and implementations. Is the assessment appropriate? No. Determine the outcome of each implementation. (1) correct-KVO (20 cc/h) will keep access open (2) need to notify physician, rate still too much since patient is in fluid overload (3) IV line may be necessary, diuretics may be ordered (4) description indicates circulatory overload, not infiltration

Extract:

Question 5 of 5

The nurse is caring for a toddler in traction, and the toddler is receiving chloral hydrate (Noctec). The toddler becomes irritable and extremely restless. Which nursing action is MOST appropriate?

A. Give the next dose of chloral hydrate early.B. Contact the physician to obtain new orders.C. Instruct the toddler's mother to read to him.D. Take the toddler out of traction for 30 minutes.

Correct Answer: B

Rationale: Irritability and restlessness suggest a paradoxical reaction to chloral hydrate, requiring physician notification for medication adjustment. Options A, C, and D are unsafe or ineffective.

NCLEX Trainer Test 10 Questions | Nurselytic

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NCLEX-PN

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