NCLEX Fundamentals Exam Test Questions with Answers Rated A
A nurse is planning care for a client who is receiving an IV
fluid infusion. Which of the following interventions should
the nurse implement to maintain asepsis? c.
a. change secondary IV infusion twice weekly the nurse should change primary iv infusion set every 96
b. change a continuously infusing IV bag after 48 hr. hr to minimize risk of infection
c. change primary IV infusion set every 96 hr
d. change extension tubing once per week
A nurse is performing a family assessment for a client
who has recently developed paraplegia following a stroke.
a.
Which of the following actions should the nurse take first?
The nurse should first determine how the client views the
a. determine how the client views the concept of family
concept of family. this will influence the nurse's decision
b. identify how culture influences family functioning
on how or whether to move forward in including the family
c. determine if the client has an external support system
into the client's plan of care.
d. identify how the family deals with unexpected health
changes
A nurse is caring for a client who has suspected clonus.
Which of the following actions should the nurse take to
a.
assess for this condition?
the reflex hammer causes the muscles to immediately
a. use a reflex hammer
contract due to a two-neuron reflex arc involving the spinal
b. administer magnesium sulfate
or brainstem segment that innervates the muscle.
c. perform a Romberg test
d. test the gait for symmetry
A nurse is preparing to mix short-acting and intermediate
acting insulin in one syringe to administer to a client with
type 1 diabetes. Put the steps in order.
e.
a. withdraw the prescribed amount of insulin from the
b.
short-acting insulin vial.
d.
b. inject the volume of air equal to the amount of insulin
to withdraw from the intermediate-acting insulin vial.
c. withdraw the prescribed amount of insulin from the
, NCLEX Fundamentals Exam Test Questions with Answers Rated A
intermediate-acting insulin vial.
d. inject the volume of air equal to the insulin dose from
a.
the short-acting insulin vial.
c.
e. draw up a volume of air equal to the volume of insulin
from the intermediate-acting insulin vial.
A nurse is assessing a client who has hypokalemia. Which
of the following findings should the nurse expect? d.
a. strong, bounding pulse decreased bowel sounds are an indication of hypokalemia
b. positive chvostek's sign because of decreased excitability of cells, resulting in less
c. hyperactive reflexes responsiveness to normal stimuli in nerves and muscles.
d. decreased bowel sounds
A nurse is assessing a client who has an NG tube and is
receiving continuous enteral feedings. The nurse auscul-
tates coarse crackles in the client's lungs. After discontinu- c.
ing the feeding, which of the following actions should the the greatest risk to this client is aspiration from possible
nurse take next? dislodgment of NG tube and aspirated stomach contents
a. prepare to initiate antibiotic therapy into the respiratory tract. Decrease exacerbation of the
b. obtain a prescription for a chest x-ray condition is to position the client on their side.
c. position the client on their side
d. suction the client's orotracheal airway
A nurse is providing teaching about cough etiquette to a
client who has influenza. Which of the following instruc-
tions should the nurse include in the teaching?
a.
a. "cover your nose and mouth with a tissue when cough-
the nurse should instruct the client to cover their nose and
ing"
mouth with a tissue when coughing and discard the tissue
b. "where gloves when preparing meals if coughing a lot"
in the nearest trash
c. "stay 2 feet away from others when coughing"
d. "turning your head away when coughing can transmit
micro-organisms into the air"
A nurse is planning care for a client who is receiving an IV
fluid infusion. Which of the following interventions should
the nurse implement to maintain asepsis? c.
a. change secondary IV infusion twice weekly the nurse should change primary iv infusion set every 96
b. change a continuously infusing IV bag after 48 hr. hr to minimize risk of infection
c. change primary IV infusion set every 96 hr
d. change extension tubing once per week
A nurse is performing a family assessment for a client
who has recently developed paraplegia following a stroke.
a.
Which of the following actions should the nurse take first?
The nurse should first determine how the client views the
a. determine how the client views the concept of family
concept of family. this will influence the nurse's decision
b. identify how culture influences family functioning
on how or whether to move forward in including the family
c. determine if the client has an external support system
into the client's plan of care.
d. identify how the family deals with unexpected health
changes
A nurse is caring for a client who has suspected clonus.
Which of the following actions should the nurse take to
a.
assess for this condition?
the reflex hammer causes the muscles to immediately
a. use a reflex hammer
contract due to a two-neuron reflex arc involving the spinal
b. administer magnesium sulfate
or brainstem segment that innervates the muscle.
c. perform a Romberg test
d. test the gait for symmetry
A nurse is preparing to mix short-acting and intermediate
acting insulin in one syringe to administer to a client with
type 1 diabetes. Put the steps in order.
e.
a. withdraw the prescribed amount of insulin from the
b.
short-acting insulin vial.
d.
b. inject the volume of air equal to the amount of insulin
to withdraw from the intermediate-acting insulin vial.
c. withdraw the prescribed amount of insulin from the
, NCLEX Fundamentals Exam Test Questions with Answers Rated A
intermediate-acting insulin vial.
d. inject the volume of air equal to the insulin dose from
a.
the short-acting insulin vial.
c.
e. draw up a volume of air equal to the volume of insulin
from the intermediate-acting insulin vial.
A nurse is assessing a client who has hypokalemia. Which
of the following findings should the nurse expect? d.
a. strong, bounding pulse decreased bowel sounds are an indication of hypokalemia
b. positive chvostek's sign because of decreased excitability of cells, resulting in less
c. hyperactive reflexes responsiveness to normal stimuli in nerves and muscles.
d. decreased bowel sounds
A nurse is assessing a client who has an NG tube and is
receiving continuous enteral feedings. The nurse auscul-
tates coarse crackles in the client's lungs. After discontinu- c.
ing the feeding, which of the following actions should the the greatest risk to this client is aspiration from possible
nurse take next? dislodgment of NG tube and aspirated stomach contents
a. prepare to initiate antibiotic therapy into the respiratory tract. Decrease exacerbation of the
b. obtain a prescription for a chest x-ray condition is to position the client on their side.
c. position the client on their side
d. suction the client's orotracheal airway
A nurse is providing teaching about cough etiquette to a
client who has influenza. Which of the following instruc-
tions should the nurse include in the teaching?
a.
a. "cover your nose and mouth with a tissue when cough-
the nurse should instruct the client to cover their nose and
ing"
mouth with a tissue when coughing and discard the tissue
b. "where gloves when preparing meals if coughing a lot"
in the nearest trash
c. "stay 2 feet away from others when coughing"
d. "turning your head away when coughing can transmit
micro-organisms into the air"
