NCLEX-PN
Emergency Nursing NCLEX Questions Questions
Extract:
Question 1 of 5
The nurse is caring for a client in the ED with abdominal trauma who has had peritoneal lavage. Which intervention should the nurse include in the plan of care?
Correct Answer: A
Rationale: Peritoneal lavage detects blood, bile, or feces, indicating internal injury. Femoral pulses, Leopold’s maneuver (pregnancy), and diet history are irrelevant.
Question 2 of 5
The nurse is responding to a disaster call from home following a multivehicle motor-vehicle accident. Which action should the nurse take first?
Correct Answer: C
Rationale: Reporting to the command center ensures coordinated assignment per disaster protocol. Triaging, discharging, or packing are secondary.
Question 3 of 5
The nurse in the emergency department administered an intramuscular antibiotic in the left gluteal muscle to the client with pneumonia who is being discharged home. Which intervention should the nurse implement?
Correct Answer: C
Rationale: Waiting 30 minutes post-antibiotic monitors for allergic reactions, critical for safety. Allergies should be checked pre-administration, sputum is diagnostic, and warm washcloths are not standard.
Question 4 of 5
Which federal agency is a resource for the nurse volunteering at the American Red Cross who is on a committee to prepare the community for any type of disaster?
Correct Answer: B
Rationale: The OEM coordinates disaster preparedness and response, a key resource for Red Cross volunteers. JC accredits facilities, DHHS oversees health, and MMRS is local.
Question 5 of 5
The nurse is caring for a client diagnosed with septic shock. Which assessment data warrant immediate intervention by the nurse?
Correct Answer: C
Rationale: Urinary output of 90 mL/4 hours = 22.5 mL/hour, below 30 mL/hour, indicating renal hypoperfusion, requiring immediate intervention. Fever, tachycardia, and elevated WBC are expected; thirst is less urgent.