Basic Care, Comfort & Mobility practice test: free NCLEX-RN questions

Sample Practice Questions for Basic Care, Comfort & Mobility

1. Question 1Ref: Physiological Integrity — Basic Care and Comfort

   A postoperative client reports severe pain rated 9 out of 10. The client has a physician order for morphine 2 mg IV every 4 hours as needed. What should the nurse do FIRST?

   AAdminister the morphine and document the pain ratingBRequest an increase in the morphine dosage from the physicianCAttempt non-pharmacological interventions before medicationDReassess the client after administering the medication
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   Correct Answer
   A. Administer the morphine and document the pain rating

   The keyed answer is "Administer the morphine and document the pain rating". With severe pain rated 9/10 and an existing order, the nurse should administer the medication promptly and document. Reassessment occurs after administration. Non-pharmacological methods are adjuncts, not replacements for severe acute pain.

2. Question 2Ref: Physiological Integrity — Basic Care and Comfort

   A client with a nasogastric tube is receiving enteral feedings. The nurse notes that the client has a distended abdomen and reports cramping. What is the priority action?

   ACheck for residual volume and slow the feeding rateBDiscontinue the feeding and remove the tubeCElevate the head of the bed 30 to 45 degreesDIncrease the rate of the feeding
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   Correct Answer
   A. Check for residual volume and slow the feeding rate

   Checking residual volume helps determine if the feedings are being absorbed properly. A high residual with distention suggests intolerance. Slowing the rate and checking for residual are appropriate interventions. Elevating the head of bed is always important but does not address the acute issue.

3. Question 3Ref: Physiological Integrity — Reduction of Risk Potential

   A client with a spinal cord injury at T6 is at risk for autonomic dysreflexia. The nurse observes a sudden increase in blood pressure and a pounding headache. What should the nurse do FIRST?

   ASit the client upright and check for bladder or bowel distentionBApply a cold compress to the foreheadCNotify the physician immediatelyDAdminister prescribed antihypertensive medication
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   Correct Answer
   A. Sit the client upright and check for bladder or bowel distention

   The keyed answer is "Sit the client upright and check for bladder or bowel distention". Autonomic dysreflexia is triggered by noxious stimuli below the level of injury, most commonly bladder or bowel distention. Sitting the client upright lowers blood pressure, and checking for distention identifies and removes the trigger.