NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
A 3-month-old is admitted to the pediatric unit with moderate dehydration. The nurse should assess the client for:
Correct Answer: B, C
Rationale: Moderate dehydration in an infant is indicated by a rapid, thready pulse and decreased skin elasticity due to fluid loss.
Question 2 of 5
The nurse is caring for a client with a history of peripheral artery disease. Which of the following interventions is most appropriate?
Correct Answer: D
Rationale: Regular walking promotes collateral circulation in peripheral artery disease, improving blood flow.
Question 3 of 5
A family may request to have a client of Vietnamese descent transferred to die at home because it is traditionally believed that:
Correct Answer: C
Rationale: In Vietnamese culture, dying at home is often preferred, as it is believed to provide more comfort and spiritual peace for the patient and family.
Question 4 of 5
A client has had an incisional cholecystectomy. Which of the following nursing interventions has the highest priority in postoperative care for this client?
Correct Answer: A
Rationale: Incentive spirometry prevents postoperative pulmonary complications, a significant risk after abdominal surgery, by promoting lung expansion.
Question 5 of 5
A nurse is caring for a client who is having an allergic reaction to a blood transfusion. In what order should the nurse provide care for this client?
Order the Items
Source Container
Correct Answer: A,C,D
Rationale: The correct order is: 1) Stop the transfusion to halt the reaction, 2) Keep the vein open with saline to maintain access, 3) Administer antihistamine to manage symptoms, and 4) Send the blood bag to the blood bank for analysis.