NCLEX Trainer Test 4 Questions

Extract:

The nurse observes the student nurse enter wearing a gown, gloves, and a mask.

Question 1 of 5

The nurse determines that the precautions are correct if the student nurse is caring for which of the following clients?

A. An infant diagnosed with respiratory syncytial virus.B. A young child with a wound infected with S aureus.C. A teenager diagnosed with toxic shock syndrome.D. A teenager diagnosed with rubella (German measles).

Correct Answer: D

Rationale: Strategy: Determine the precautions required for each disease. (1) requires contact precautions, no mask (2) requires contact precautions, no mask (3) standard precautions (4) correct-droplet precautions used for organisms that can be transmitted by face-to-face contact, door may remain open

Extract:

Question 2 of 5

An adult who was struck by lightning is brought to the emergency department. Which action is of highest priority when the client is brought to the emergency room?

A. Obtain an ECGB. Check blood gassesC. Dress woundsD. Check electrolytes

Correct Answer: A

Rationale: Lightning strikes can cause cardiac arrhythmias; obtaining an ECG is the highest priority to detect life-threatening rhythm disturbances. Gases, wounds, and electrolytes are secondary.

Extract:

The nurse returns to the nurse's station after making client rounds and finds four phone messages.

Question 3 of 5

Which of the following messages should the nurse return FIRST?

A. A client with hepatitis A who states, 'My arms and legs are itching.'B. A client with a cast on the right leg who states, 'I have a funny feeling in my right leg.'C. A client with osteomyelitis of the spine who states, 'I am so nauseous that I can't eat.'D. A client with arthritis who states, 'I am having trouble sleeping at night.'

Correct Answer: B

Rationale: Strategy: Eliminate the most stable clients. (1) caused by accumulation of bile salts under the skin; treat with calamine lotion and antihistamines (2) correct-may indicate neurovascular compromise; requires immediate assessment (3) requires follow-up but not highest priority (4) requires assessment but not the highest priority

Extract:

Question 4 of 5

The nurse is caring for a client with a history of seizures.

A. What is the priority action for the nurse during a client’s tonic-clonic seizure?B. Restrain the client’s limbs to prevent injury.C. Place a padded tongue blade in the client’s mouth.D. Turn the client to the side to maintain airway.E. Administer lorazepam (Ativan) immediately.

Correct Answer: C

Rationale: Turning the client to the side during a seizure maintains an open airway, preventing aspiration and ensuring oxygenation, which is the priority. Restraining limbs risks injury, tongue blades are contraindicated, and medication administration follows airway management.

Question 5 of 5

The nurse is caring for a client with a history of schizophrenia who is receiving haloperidol (Haldol) 5 mg PO bid. Which of the following symptoms should the nurse report immediately?

A. Dry mouth.B. Mild sedation.C. Muscle stiffness and tremors.D. Insomnia.

Correct Answer: C

Rationale: Muscle stiffness and tremors suggest extrapyramidal symptoms, a serious haloperidol side effect. Options A, B, and D are less urgent.

NCLEX Trainer Test 4 Questions | Nurselytic

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