NCLEX-RN Exam Pack Set 4 (75 Questions & Answers Updated 2022)
1. 1. Question
Which action(s) should you delegate to the experienced nursing assistant
... [Show More] when caring for a patient with a thrombotic stroke with residual left-sided weakness? Select all that apply.
o A. Assist the patient to reposition every 2 hours.
o B. Reapply pneumatic compression boots.
o C. Remind the patient to perform active ROM.
o D. Check extremities for redness and edema.
• 2. Question
The patient who had a stroke needs to be fed. What instruction should you give to the nursing assistant who will feed the patient?
o A. Position the patient sitting up in bed before you feed her.
o B. Check the patient’s gag and swallowing reflexes.
o C. Feed the patient quickly because there are three more waiting.
o D. Suction the patient’s secretions between bites of food.
• 3. Question
You have just admitted a patient with bacterial meningitis to the medical-surgical unit. The patient complains of a severe headache with photophobia and has a temperature of 102.60 F orally. Which collaborative intervention must be
accomplished first?
o A. Administer codeine 15 mg orally for the patient’s headache.
o B. Infuse ceftriaxone (Rocephin) 2000 mg IV to treat the infection.
o C. Give acetaminophen (Tylenol) 650 mg orally to reduce the fever.
o D. Give furosemide (Lasix) 40 mg IV to decrease intracranial pressure.
• 4. Question
You are mentoring a student nurse in the intensive care unit (ICU) while caring for a patient with meningococcal meningitis. Which action by the student requires that you intervene immediately?
o A. The student enters the room without putting on a mask and gown.
o B. The student instructs the family that visits are restricted to 10 minutes.
o C. The student gives the patient a warm blanket when he says he feels cold.
o D. The student checks the patient’s pupil response to light every 30 minutes.
• 5. Question
A 23-year-old patient with a recent history of encephalitis is admitted to the medical unit with new-onset generalized tonic- clonic seizures. Which nursing activities included in the patient’s care will be best to delegate to an LPN/LVN whom you are supervising? Select all that apply.
o A. Document the onset time, nature of seizure activity, and postictal behaviors for all seizures.
o B. Administer phenytoin (Dilantin) 200 mg PO daily.
o C. Teach the patient about the need for good oral hygiene.
o D. Develop a discharge plan, including physician visits and referral to the Epilepsy Foundation.
o E. Gather information about the seizure activity
• 6. Question
While working in the ICU, you are assigned to care for a patient with a seizure disorder. Which of these nursing actions will you implement first if the patient has a seizure?
o A. Place the patient on a non-rebreather mask will the oxygen at 15 L/minute.
o B. Administer lorazepam (Ativan) 1 mg IV.
o C. Turn the patient to the side and protect the airway.
o D. Assess level of consciousness during and immediately af [Show Less]