Nclex-RN practice test
A 1-day-old newborn diagnosed with intrauterine growth retardation is observed
by the nurse to be restless, irritable, and first-sucking, and having a high-pitched,
shrill cry. Based on this data, which of the following actions should the nurse
take FIRST?
1. Massage the infant's back.
2. Tightly swaddle the infant in a flexed position
3. Schedule feeding times every 3 to 4 hours.
4. Encourage eye contact with the infant during feeding - ANS - 2.
\A 46-year-old man is admitted to the hospital with a fractured right femur. He is
placed in balanced suspension traction with a Thomas splint and Pearson
attachment. During the first 48 hr, the nurse should assess the client for which of
the following complications?
1. Pulmonary embolism
2. Fat embolism
3. Avascular necrosis
4. Malunion - ANS - 2.
\A 6-year-old child with a congenital heart disorder is admitted with congestive
heart failure. Digoxin 0.12mg is ordered for the child. The bottle contain 0.05 mg
of digoxin in 1 mL of solution. Which of the following amounts should the nurse
administer to the child?
1. 1.2 mL
2. 2.4 mL
3. 3.5 mL
4.4.2 mL - ANS - 2.
\A 70-year-old women is brought to the emergency room for treatment after being
found on the floor by her daughter. X-rays reveal a displaced subcapital fracture
of the left hip and osteoarthritis. When comparing the leg, the nurse would most
likely make which of the following observation?
1. The client's left leg is longer than the right leg and externally rotated.
2. The client's left leg is shorter than the right leg and internally rotated
3. The client's left leg is shorter than the right leg and adducted.
4. The client's left leg is longer than the right leg and is abducted. - ANS - 1.
\A client is admitted who reports severe pain in the right lower quadrant of the
abdomen. To assist with pain relief, the nurse should take which of the following
actions?
1. Encourage the client to change positions frequently in bed.
, 2. Massage the right lower quadrant of the abdomen.
3. Apply warmth to the abdomen with a heating pad.
4. Use comfort measures and pillows to position the client - ANS - 4.
\A client is telling the nurse about his perception of his thought patterns. Which
of the following statements by the client would validate the diagnosis of
schizophrenia
1. "I can't get the same thoughts out of my head."
2. "I know I sometimes feel on top of the world, then suddenly down."
3. "Sometimes I look up and wonder where I am."
4. "It's clear that this is an alien laboratory and I am in charge" - ANS - 4.
\A client reports pain in his right lower extremity. The physician orders codeine60
mg and aspirin grains X PO every 4 hours, as needed for pain. Each codeine
tablet contains 15 mg of codeine. Each aspirin tablet contains 325 mg of aspirin.
Which of the following should the nurse administer?
1. 2 codeine tablets and 4 aspirin tablets
2. 4 codeine tablets and 3 aspirin tablets
3. 4 codeine tablets and 2 aspirin tablets
4. 3 codeine tablets and 3 aspirin tablets - ANS - 3.
\A client with a history of alcoholism is brought to the emergency room in an
agitated state. He is vomiting and diaphoretic. He says he had his last drink 5
hours ago. The nurse would expect to administer which of the following
medications?
1. Chlordiazepoxide hydrochloride
2. Disulfiram
3. Methadone hydrochloride
4. Naloxone hydrochloride - ANS - 1.
\A client with emphysema becomes restless and confused. Which of the following
steps should the nurse take next?
1. Encourage the client to perform pursed lip breathing.
2. Check the client's temperature.
3. Asses the client's potassium level.
4. Increase the client's oxygen flow rate to 5 L/mIn. - ANS - 1.
\A nurse in the outpatient clinic evaluates the Mantoux test of a client whose
history indicates that she has been treated during the past year for an AIDS-
related infection. The nurse should document that there was a positive reaction if
there is an area of induration measuring which of the following?
1. 1 mm
2. 3 mm
3. 5 mm
4. 7 mm - ANS - 4.
A 1-day-old newborn diagnosed with intrauterine growth retardation is observed
by the nurse to be restless, irritable, and first-sucking, and having a high-pitched,
shrill cry. Based on this data, which of the following actions should the nurse
take FIRST?
1. Massage the infant's back.
2. Tightly swaddle the infant in a flexed position
3. Schedule feeding times every 3 to 4 hours.
4. Encourage eye contact with the infant during feeding - ANS - 2.
\A 46-year-old man is admitted to the hospital with a fractured right femur. He is
placed in balanced suspension traction with a Thomas splint and Pearson
attachment. During the first 48 hr, the nurse should assess the client for which of
the following complications?
1. Pulmonary embolism
2. Fat embolism
3. Avascular necrosis
4. Malunion - ANS - 2.
\A 6-year-old child with a congenital heart disorder is admitted with congestive
heart failure. Digoxin 0.12mg is ordered for the child. The bottle contain 0.05 mg
of digoxin in 1 mL of solution. Which of the following amounts should the nurse
administer to the child?
1. 1.2 mL
2. 2.4 mL
3. 3.5 mL
4.4.2 mL - ANS - 2.
\A 70-year-old women is brought to the emergency room for treatment after being
found on the floor by her daughter. X-rays reveal a displaced subcapital fracture
of the left hip and osteoarthritis. When comparing the leg, the nurse would most
likely make which of the following observation?
1. The client's left leg is longer than the right leg and externally rotated.
2. The client's left leg is shorter than the right leg and internally rotated
3. The client's left leg is shorter than the right leg and adducted.
4. The client's left leg is longer than the right leg and is abducted. - ANS - 1.
\A client is admitted who reports severe pain in the right lower quadrant of the
abdomen. To assist with pain relief, the nurse should take which of the following
actions?
1. Encourage the client to change positions frequently in bed.
, 2. Massage the right lower quadrant of the abdomen.
3. Apply warmth to the abdomen with a heating pad.
4. Use comfort measures and pillows to position the client - ANS - 4.
\A client is telling the nurse about his perception of his thought patterns. Which
of the following statements by the client would validate the diagnosis of
schizophrenia
1. "I can't get the same thoughts out of my head."
2. "I know I sometimes feel on top of the world, then suddenly down."
3. "Sometimes I look up and wonder where I am."
4. "It's clear that this is an alien laboratory and I am in charge" - ANS - 4.
\A client reports pain in his right lower extremity. The physician orders codeine60
mg and aspirin grains X PO every 4 hours, as needed for pain. Each codeine
tablet contains 15 mg of codeine. Each aspirin tablet contains 325 mg of aspirin.
Which of the following should the nurse administer?
1. 2 codeine tablets and 4 aspirin tablets
2. 4 codeine tablets and 3 aspirin tablets
3. 4 codeine tablets and 2 aspirin tablets
4. 3 codeine tablets and 3 aspirin tablets - ANS - 3.
\A client with a history of alcoholism is brought to the emergency room in an
agitated state. He is vomiting and diaphoretic. He says he had his last drink 5
hours ago. The nurse would expect to administer which of the following
medications?
1. Chlordiazepoxide hydrochloride
2. Disulfiram
3. Methadone hydrochloride
4. Naloxone hydrochloride - ANS - 1.
\A client with emphysema becomes restless and confused. Which of the following
steps should the nurse take next?
1. Encourage the client to perform pursed lip breathing.
2. Check the client's temperature.
3. Asses the client's potassium level.
4. Increase the client's oxygen flow rate to 5 L/mIn. - ANS - 1.
\A nurse in the outpatient clinic evaluates the Mantoux test of a client whose
history indicates that she has been treated during the past year for an AIDS-
related infection. The nurse should document that there was a positive reaction if
there is an area of induration measuring which of the following?
1. 1 mm
2. 3 mm
3. 5 mm
4. 7 mm - ANS - 4.
