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NCLEX NCLEX-RN Exam
National Council Licensure Examination - NCLEX-RN (Page 6 )

Updated On: 12-Jan-2026
Page 6 of 345
PDF with 862 Questions

A 13-year-old hemophiliac is hospitalized for hemarthrosis of his right knee. To relieve the pain, the nurse should:

  1. Place on bed rest; elevate and splint the right knee
  2. Apply moist heat to the right knee
  3. Administer aspirin for pain
  4. Encourage active range of motion to right knee

Answer(s): A

Explanation:

(A) Immobilization, splinting, and bed rest will reduce the bleeding. Once bleeding is reduced or stopped, the pain will subside. (B) Moist heat causes vasodilation and bleeding. Ice or cold compresses should be applied. (C) Aspirin decreases platelet aggregation, which causes bleeding. (D) Active range of motion aggravates bleeding and damages the synovial sac during bleeding episodes.



A client's physician has prescribed theophylline (Theo- Dur) to help control the bronchospasm associated with the client's COPD. Instructions that should be given to the client include:

  1. "Call your physician if you develop palpitations, dizziness, or restlessness.''
  2. "Cigarette smoking may significantly increase the risk for theophylline toxicity.''
  3. "Take this medication on an empty stomach.''
  4. "Do not take your medicine if your pulse is less than 60 beats per minute.''

Answer(s): A

Explanation:

(A) Indications of theophylline toxicity include palpitations, dizziness, restlessness, nausea, vomiting, shakiness, and anorexia. (B) Cigarette smoking significantly lowers theophylline plasma levels. (C) Theophylline should be taken with food to decrease stomach upset. (D) These instructions are appropriate for someone taking digoxin.



A 19-year-old client fell off a ladder approximately 3 ft to the ground. He did not lose consciousness but was taken to the emergency department by a friend to have a scalp laceration sutured. The nurse instructs the client to:

  1. Clean the sutured laceration twice a day with povidone- iodine (Betadine)
  2. Remove his scalp sutures after 5 days
  3. Return to the hospital immediately if he develops confusion, nausea, or vomiting
  4. Take meperidine 50 mg po q4­6h prn for headache

Answer(s): C

Explanation:

(A) Povidone-iodine is very irritating to skin and should not be routinely used. (B) Sutures should not be removed by the client. (C) Confusion, nausea, vomiting, and behavioral changes may indicate increasing intracranial pressure as a result of intracerebral bleeding. (D) Use of a narcotic opiate such as meperidine is not recommended in clients with a possible head injury because it may produce sedation, pupil changes, euphoria, and respiratory depression, which may mask the signs of increasing intracranial pressure.



A type I diabetic client delivers a male newborn. The newborn is 45 minutes old. What is the primary nursing goal in the nursery during the first hours for this newborn?

  1. Bonding
  2. Maintain normal blood sugar
  3. Maintain normal nutrition
  4. Monitor intake and output

Answer(s): B

Explanation:

(A) Bonding is necessary but would not be the priority with this newborn in the nursery. (B) The infant will be at risk for hypoglycemia because of excess insulin production. (C) Normal nutrition is a goal for all newborns. (D) Monitoring intake and output is necessary but is not the most critical nursing goal.



A primigravida is at term. The nurse can recognize the second stage of labor by the client's desire to:

  1. Push during contractions
  2. Hyperventilate during contractions
  3. Walk between contractions
  4. Relax during contractions

Answer(s): A

Explanation:

(A) The second stage of labor is characterized by uterine contractions, which cause the client to bear down. (B) Slow, deep, rhythmic breathing facilitates the laboring process. Hyperventilation is abnormal breathing resulting from loss of pain control. (C) The client should remain on bed rest during labor. (D) Contractions result in discomfort.



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