NCLEX-RN
Basic Adult Health Care NCLEX Questions Questions
Extract:
Question 1 of 5
When using a Doppler instrument to assess peripheral pulses, the correct placement of the transducer is important because it is difficult to differentiate between:
Correct Answer: B
Rationale: Doppler ultrasound can detect both arterial (pulsatile) and venous (continuous) blood flow, but incorrect transducer placement may confuse these signals. Differentiating arterial from venous flow is critical in PVD assessment to confirm arterial patency. Capillary or arteriole flow is less relevant in this context.
Question 2 of 5
A nursing assistant is providing care to a client with left-sided paralysis. Which of the following actions by the nursing assistant requires the nurse to provide further instruction?
Correct Answer: C
Rationale: Pulling under the paralyzed shoulder can cause injury or discomfort. Passive ROM, elevating the bed, and high-top shoes are appropriate for paralysis care.
Question 3 of 5
The nurse is teaching a diabetic client using an empowerment approach. The nurse should initiate teaching by asking which of the following?
Correct Answer: D
Rationale: An empowerment approach focuses on the client's knowledge and needs. Starting with what the client already knows about their condition and medications helps tailor education effectively.
Question 4 of 5
The nurse finds an unlicensed assistive personnel massaging the reddened bony prominences of a client on bed rest. The nurse should:
Correct Answer: D
Rationale: Massaging reddened bony prominences is contraindicated, as it can damage fragile tissue and reduce blood flow, worsening the risk of pressure ulcers.
Question 5 of 5
A client with disseminated intravascular coagulation develops ventricular microvascular thrombosis. The nurse should assess the client for:
Correct Answer: B
Rationale: Microvascular thrombosis in DIC can cause focal ischemia by obstructing small vessels, leading to tissue damage in organs like the kidneys or brain. Hemoptysis, petechiae, and hematuria are related to bleeding, not thrombosis.