NCLEX-RN
NCLEX RN Practice Questions With Rationale
1. In a clinic in a primarily African American community, a higher incidence of uncontrolled hypertension is noted in patients. To correct this health disparity, what should the nurse do first?
- A. Initiate a regular home-visit program by clinic nurses.
- B. Schedule teaching sessions about low-salt diets at community events.
- C. Assess the perceptions of community members about the care at the clinic.
- D. Obtain low-cost antihypertensive drugs using government grant funding.
Correct answer: C
Rationale: To address the higher incidence of uncontrolled hypertension in the primarily African American community, the nurse should first assess the perceptions of community members about the care at the clinic. Understanding the community's perspective can provide valuable insights into the reasons behind the health disparity. Initiating a regular home-visit program or scheduling teaching sessions about low-salt diets are important interventions but should come after gathering information on community perceptions. Obtaining low-cost antihypertensive drugs is not the initial priority; understanding community perspectives is crucial for developing effective interventions.
2. At the beginning of her shift in a long-term care facility, which of the following clients should a nurse check on first?
- A. A 91-year-old man who needs help eating breakfast
- B. An 86-year-old man who has been incontinent in his bed
- C. An 82-year-old woman who needs IV antibiotics
- D. A 75-year-old man who is recovering from an injury and needs an ice pack
Correct answer: C
Rationale: When prioritizing care in a long-term care facility, the nurse must consider tasks that require their immediate attention and cannot be delegated. Administering IV antibiotics is a critical nursing task that only the nurse can perform, ensuring the timely and correct delivery of medication to the patient. While assisting with breakfast, managing incontinence, and providing an ice pack are important, these tasks can be delegated to other healthcare team members, allowing the nurse to address the client needing IV antibiotics first to ensure effective treatment and patient safety.
3. What is the highest priority for post ECT care?
- A. Observe for confusion
- B. Monitor respiratory status
- C. Reorient to time, place, and person
- D. Document the client's response to the treatment
Correct answer: B
Rationale: The highest priority for post ECT care is to monitor respiratory status. This is crucial because a life-threatening side effect of ECT is respiratory arrest. While observing for confusion and reorienting the client are important aspects of post ECT care, they are not as critical as ensuring the client's respiratory status is stable. Documenting the client's response to treatment is also important for maintaining accurate medical records, but it is not the highest priority immediately post ECT.
4. When a mother is inquiring about her child's ability to potty train, what is the most critical aspect of toilet training?
- A. The age of the child
- B. The child's ability to understand instructions
- C. The overall mental and physical abilities of the child
- D. Consistent attempts with positive reinforcement
Correct answer: C
Rationale: The most critical aspect of toilet training is the overall mental and physical abilities of the child. While age can play a role, it is not the sole determining factor. Understanding instructions is important but may not be the most critical aspect. Consistent attempts with positive reinforcement can be helpful, but without considering the child's abilities, it may not lead to successful potty training.
5. Asepsis is defined as ________________.
- A. the absence of all microorganisms
- B. the absence of disease-causing germs
- C. a urinary infection
- D. a pathogenic infection
Correct answer: B
Rationale: Asepsis is defined as the absence of disease-causing germs. It is surgical asepsis that is defined as the absence of all microorganisms, including spores. A pathogenic infection is an invasion of the body by a pathogen, or disease-causing germ, and a urinary infection is only one type of infection.
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