Complete Question Bank

NCLEX RN· Full Length · NCLEX RN Nursing Exam

Full Question & Rationale Repository

Showing all 10 practice questions with expert explanatory rationales.

Question 1 of 10

An adolescent client hospitalized with anorexia nervosa is described by her parents as 'the perfect child.' When planning care for the client, the nurse should:

A. Allow her to choose what foods she will eat
B. Provide activities to foster her self-identity
C. Encourage her to participate in morning exercise
D. Provide a private room near the nurse's station

Expert Explanatory Rationale

Correct Answer: Provide activities to foster her self-identity

Question 2 of 10

The nurse is caring for a client with a diagnosis of abruptio placenta. Which nursing intervention is most appropriate?

A. Monitor fetal heart tones
B. Administer oxygen at 2 liters per minute
C. Place the client in Trendelenburg position
D. Increase IV fluid rate

Expert Explanatory Rationale

Correct Answer: Monitor fetal heart tones

Question 3 of 10

A burn client's care plan reveals an expected outcome of no localized or systemic infection. Which assessment by the nurse supports this outcome?

A. Wound culture results showing minimal bacteria
B. Cloudy, foul-smelling urine
C. White blood cell count of 14,000/mm3
D. Temperature elevation of 101°F

Expert Explanatory Rationale

Correct Answer: Wound culture results showing minimal bacteria

Question 4 of 10

A client was admitted with rib fractures and a pneumothorax, which were sustained as a result of a motor vehicle accident. A chest tube was placed on the left side to reinflate his lung, and he was transferred to a client unit. Twenty-four hours after admission he continues to have bloody sputum, develops increasing hypoxemia, and his chest x-ray shows patchy infiltrates. The nurse analyzes these symptoms as being consistent with:

A. Pneumonia
B. Pulmonary contusions
C. Pulmonary edema
D. Tension pneumothorax

Expert Explanatory Rationale

Correct Answer: Pulmonary contusions

Question 5 of 10

Which nursing interventions are included in the post-operative care of the client following the repair of a retinal detachment with instillation of silicone oil?

A. Placing the client in a prone position
B. Maintaining strict bed rest for 24 hours
C. Offering a clear liquid diet
D. Instructing the client to keep his head bowed when sitting upright
E. Applying an eye patch to protect the affected eye from light

Expert Explanatory Rationale

Correct Answer:

Question 6 of 10

On the third postpartum day, the nurse would expect the lochia to be:

A. Rubra
B. Serosa
C. Alba
D. Scant

Expert Explanatory Rationale

Correct Answer: Rubra

Question 7 of 10

A 55-year-old client is admitted with a diagnosis of renal calculi. He presented with severe right flank pain, nausea, and vomiting. The most important nursing action for him at this time is:

A. Intake and output measurement
B. Daily weights
C. Straining of all urine
D. Administration of O₂ therapy

Expert Explanatory Rationale

Correct Answer: Straining of all urine

Question 8 of 10

The family member of a child scheduled for heart surgery states, 'I just don't understand this open-heart or closed-heart business. I'm so confused! Can you help me understand it?' The nurse explains that patent ductus arteriosus repair is:

A. Open-heart surgery. The child will be placed on a heart-lung machine while the surgery is being performed.
B. Closed-heart surgery. It does not require that the child be placed on the heart-lung machine while the surgery is being performed.
C. A pediatric version of the coronary artery bypass graft surgery performed on adults. It is an open-heart surgery.
D. A pediatric version of percutaneous transluminal coronary angioplasty performed on adults. It is a closed-heart surgery.

Expert Explanatory Rationale

Correct Answer: Closed-heart surgery. It does not require that the child be placed on the heart-lung machine while the surgery is being performed.

Question 9 of 10

The nurse is caring for a client with a diagnosis of gestational trophoblastic disease. Which laboratory value is most likely to be elevated?

A. Human chorionic gonadotropin (hCG)
B. Alpha-fetoprotein (AFP)
C. Estriol
D. Progesterone

Expert Explanatory Rationale

Correct Answer: Human chorionic gonadotropin (hCG)

Question 10 of 10

The client is diagnosed with a pneumothorax. Which finding is most expected on auscultation?

A. Bilateral crackles
B. Diminished breath sounds on the affected side
C. Wheezing throughout lung fields
D. Rhonchi in the lower lobes

Expert Explanatory Rationale

Correct Answer: Diminished breath sounds on the affected side