NCLEX-RN
NCLEX RN SATA Questions Questions
Extract:
Question 1 of 5
A 4-year-old child is admitted with dehydration due to gastroenteritis. Which assessment finding indicates severe dehydration?
Correct Answer: C
Rationale: Sunken fontanelles in a young child are a sign of severe dehydration, indicating significant fluid loss requiring urgent rehydration.
Question 2 of 5
A client with a history of type 2 diabetes is prescribed exenatide (Byetta). The nurse should instruct the client to:
Correct Answer: A, B
Rationale: Exenatide is taken before meals to control postprandial glucose, and hypoglycemia is a risk.
Question 3 of 5
On the first postpartum day, the nurse is caring for a primiparous client who has recently emigrated from Japan to the United States and speaks only a little English. The nurse observes that the client has been bottle-feeding her neonate on occasion, but most of the neonatal care is being performed by the client's mother-in-law. Which of the following actions would be most appropriate?
Correct Answer: C
Rationale: Assessing whether the mother-in-law's involvement is a cultural practice respects the client's background and avoids misjudging normal family dynamics.
Question 4 of 5
The nurse is evaluating the client's potential for development of a pressure sore. Which of the following individual characteristics would be the best indicator of risk for the client's developing a pressure sore?
Correct Answer: C
Rationale: Immobility is the primary risk factor for pressure sores, as it leads to prolonged pressure on tissues.
Question 5 of 5
A client with a history of depression is prescribed citalopram (Celexa). The nurse should instruct the client to:
Correct Answer: A
Rationale: Citalopram can cause serotonin syndrome, requiring monitoring for agitation and tremors.