RN Comprehensive Online Practice (NCLEX 1-5)

Nurses who will be taking the NCLEX exam should take our RN Comprehensive Online Practice quizzes. These free questions will help you enhance your critical thinking skills and make you more prepared for the actual exam.1. The nurse is teaching a client with emphysema about positions that help breathing during dyspneic episodes. The nurse instructs the client to avoid which position that could aggravate breathing?
a) Sitting up and leaning on a table
b) Standing and leaning against a wall
c) Sitting up with the elbows resting on knees
d) Lying on the back in a low-Fowler’s position

2. RN Comprehensive Online Practice question about a client who is about to undergo a lumbar puncture. The nurse describes to the client that which position will be used during the procedure?

a) Side-lying with a pillow under the hip
b) Prone with a pillow under the abdomen
c) Prone in slight Trendelenburg’s position
d) Side-lying with the legs pulled up and the head bent down onto the chest

3. The nurse recognizes that which intervention is unlikely to facilitate effective communication between a dying client and family?

a) The nurse encourages the client and family to identify and discuss feelings openly.
b) The nurse assists the client and family in carrying out spiritually meaningful practices.
c) The nurse makes decisions for the client and family to relieve them of unnecessary demands.
d) The nurse maintains a calm attitude and one of acceptance when the family or client expresses anger.

4. RN Comprehensive Online Practice question about a depressed client who verbalizes feelings of low self-esteem and self-worth typified by statements such as “I’m such a failure. I can’t do anything right.” How should the nurse plan on responding to the client’s statement?

a) Reassure the client that things will get better.
b) Tell the client that this is not true and that we all have a purpose in life.
c) Identify recent behaviors or accomplishments that demonstrate the client’s skills.
d) Remain with the client and sit in silence; this will encourage the client to verbalize feelings.

5. The nurse has just admitted to the nursing unit a client with a basilar skull fracture who is at risk for increased intracranial pressure. Pending specific health care provider prescriptions, the nurse should safely place the client in which positions? Select all that apply. 

a) Head midline
b) Neck in neutral position
c) Head of bed elevated 30 to 45 degrees
d) Head turned to the side when flat in bed 5. Neck and jaw flexed forward when opening the mouth

RN Comprehensive Online Practice
Answers and Rationale

1) D
- Rationale: The client should use the positions outlined in options A, B, and C. These allow for maximal chest expansion. The client should not lie on the back because it reduces movement of a large area of the client’s chest wall. Sitting is better than standing, whenever possible. If no chair is available, leaning against a wall while standing allows accessory muscles to be used for breathing and not posture control.

- Test-Taking Strategy: Focus on the subject, the positions to avoid that could aggravate breathing. Also, note that options A, B, and C are comparable or alike in that they all address upright positions.

2) D
- Rationale: A client undergoing lumbar puncture is positioned lying on the side, with the legs pulled up to the abdomen and the head bent down onto the chest. This position helps open the spaces between the vertebrae and allows for easier needle insertion by the health care provider. The nurse remains with the client during the procedure to help the client maintain this position. The other options identify incorrect positions for this procedure.

- RN Comprehensive Online Practice Test-Taking Strategy: Focus on the subject, lumbar puncture. Recalling that a lumbar puncture is the introduction of a needle into the subarachnoid space will direct you to the correct option. It is reasonable that the position of the client must facilitate this, and the correct option is the only position that flexes the vertebrae and widens the spaces between them.

3) C
- Rationale: Maintaining effective and open communication among family members affected by death and grief is of the greatest importance. Option A describes encouraging discussion of feelings and is likely to enhance communications. Option B is also an effective intervention because spiritual practices give meaning to life and have an impact on how people react to crisis. Option D is also an effective technique because the client and family need to know that someone will be there who is supportive and nonjudgmental. The correct option describes the nurse removing autonomy and decision-making from the client and family, who are already experiencing feelings of loss of control in that they cannot change the process of dying. This is an ineffective intervention, which could impair communication further.

- RN Comprehensive Online Practice Test-Taking Strategy: Focus on the subject, the intervention that is unlikely to facilitate effective communication. Use of therapeutic communication techniques and focusing on the subject will assist in answering correctly. Also, understanding that people in crisis usually feel helpless and unable to control their circumstances can assist in identifying the correct option as a response that further removes control.

4) C
- Rationale: Feelings of low self-esteem and worthlessness are common symptoms of a depressed client. An effective plan of care to enhance the client’s personal self-esteem is to provide experiences for the client that are challenging, but that will not be met with failure. Reminders of the client’s past accomplishments or personal successes are ways to interrupt the client’s negative self-talk and distorted cognitive view of self. Options A and B give advice and devalue the client’s feelings. Silence may be interpreted as agreement.

- RN Comprehensive Online Practice Test-Taking Strategy: Use therapeutic communication techniques and focus on the client’s diagnosis. You can eliminate options A and B easily because they are nontherapeutic. From the remaining options, focusing on the client’s diagnosis will direct you to the correct option.

5) A, B, C
- Rationale: Use of proper positions promotes venous drainage from the cranium to keep intracranial pressure from elevating.The head of the client at risk for or with increased intracranial pressure should be positioned so that the head is in a neutral, midline position. The head of the bed should be raised to 30 to 45 degrees. The nurse should avoid flexing or extending the neck or turning the head from side to side.

- Test-Taking Strategy: Focus on the subject, care of the client with increased intracranial pressure. Visualize each of the positions identified in the options and identify those that will promote venous drainage from the cranium.

Proceed to the next set of questions:

RN Comprehensive Online Practice 6-10