NCLEX-RN
Best NCLEX RN Question Bank Questions
Extract:
Question 1 of 5
A client with a history of heart failure is prescribed spironolactone (Aldactone). Which electrolyte imbalance should the nurse monitor for?
Correct Answer: B
Rationale: Spironolactone, a potassium-sparing diuretic, can cause hyperkalemia, requiring monitoring to prevent arrhythmias.
Question 2 of 5
A mother who is Mexican brings her 2-month-old son to the emergency department with a high fever and possible sepsis. A lumbar puncture is ordered, but the mother will not sign the consent until the father arrives to give permission. The nurse should:
Correct Answer: C
Rationale: Respecting cultural norms, where the father may be the decision-maker, the nurse should wait for the father to arrive for consent, especially in a non-immediate life-threatening situation. Reporting to social services or claiming refusal is premature without further assessment.
Question 3 of 5
A client with a history of multiple sclerosis is admitted with muscle weakness. The nurse should include which of the following in the plan of care?
Correct Answer: A
Rationale: Assisting with activities of daily living supports safety and independence in multiple sclerosis.
Question 4 of 5
A client with a fracture is placed in skeletal traction. What is the nurse's priority assessment?
Correct Answer: A
Rationale: Monitoring skin integrity at pin sites is critical to detect infection or tissue breakdown in skeletal traction.
Question 5 of 5
A client with diabetes is explaining to the nurse how she will care for her feet at home. Which statement indicates that the client understands proper foot care?
Correct Answer: D
Rationale: Thorough drying prevents moisture-related infections, critical for diabetic foot care to avoid complications like ulcers.