RN NCLEX-RN Basic Care & Comfort 2

Question 1

A nurse is caring for a client who is immobile and at risk for pressure injuries. Which intervention has the highest priority?

Accepted Answer

Reposition the client every 2 hours

Answer

Repositioning every 2 hours is the primary intervention to relieve sustained pressure on bony prominences and prevent tissue ischemia.

Question 2

A postoperative client refuses to use the incentive spirometer. Which response by the nurse is most therapeutic?

Accepted Answer

Explain that using it prevents serious lung complications such as pneumonia

Answer

Educating the client about the rationale (preventing atelectasis and pneumonia) supports informed decision-making and may improve adherence.

Question 3

When providing oral hygiene to an unconscious client, what is the most important safety measure?

Accepted Answer

Place the client in a lateral position with head turned to the side

Answer

A lateral position with the head turned to the side uses gravity to prevent aspiration of fluids in an unconscious client.

Question 4

A nurse is preparing to insert a urinary catheter in a female client. After opening the sterile field, which action would require the nurse to start over?

Accepted Answer

Reaching across the sterile field to arrange supplies

Answer

Reaching across a sterile field contaminates it because the unsterile arm passes over the field; the nurse must start over with a new kit.

Question 5

A client with a nasogastric tube reports nausea. Before administering an antiemetic, the nurse should first:

Accepted Answer

Check the placement of the nasogastric tube

Answer

Verifying NG tube placement rules out tube displacement into the esophagus as a cause of nausea before any intervention.

RN - Registered Nurse Practice Test

RN - Registered Nurse Practice Test

RN NCLEX-RN Basic Care & Comfort 2