NCLEX-RN
NCLEX RN SATA Questions Questions
Extract:
Question 1 of 5
A client has been hospitalized with heart failure. He is receiving digoxin (Lanoxin) and furosemide (Lasix) intravenously. He tells the nurse that he hears a continuous ringing in his ears and that he has never had this problem before. What is the appropriate action for the nurse to take at this time?
Correct Answer: A
Rationale: Ringing in the ears (tinnitus) is a sign of digoxin toxicity, requiring immediate checking of digoxin levels. Aspirin is less likely to cause this, and discontinuing furosemide or delaying action is inappropriate.
Question 2 of 5
A primiparous client at 48 hours postpartum is to be given medroxyprogesterone acetate (Depo-Provera) before discharge. Which of the following should the nurse include in the teaching plan before administering this medication?
Correct Answer: B
Rationale: Amenorrhea is a common side effect of Depo-Provera, especially in the first 6 months, and should be included in client teaching. The other options are incorrect.
Question 3 of 5
A client with cirrhosis is admitted with ascites. The nurse should monitor the client for which of the following complications?
Correct Answer: A
Rationale: Ascites can cause diaphragmatic compression, leading to respiratory distress, which requires monitoring.
Question 4 of 5
The nurse is caring for a client with a history of gastric bypass surgery. Which of the following vitamins is the client at highest risk for deficiency?
Correct Answer: B
Rationale: Gastric bypass surgery impairs vitamin B12 absorption due to reduced intrinsic factor production, increasing deficiency risk.
Question 5 of 5
Which of the following assessment finding is expected in a client with bacterial pneumonia?
Correct Answer: A
Rationale: Increased fremitus is expected in bacterial pneumonia due to lung consolidation.