NCLEX-RN
NCLEX RN SATA Questions Questions
Extract:
Question 1 of 5
A client with a history of hypothyroidism is admitted with fatigue. The nurse should monitor the client for which of the following laboratory abnormalities?
Correct Answer: A, B
Rationale: Hypothyroidism presents with elevated TSH and decreased free T4.
Question 2 of 5
When a breast-feeding mother reports experiencing nipple soreness, the nurse provides teaching regarding measures to relieve the soreness. Which statement by the mother indicates an understanding of the teaching?
Correct Answer: D
Rationale: Comfort measures for nipple soreness include positioning the infant with the ear, shoulder, and hip in straight alignment and with the infant's stomach against the mother's. Additional measures include rotating breastfeeding positions, breaking suction with the little finger, nursing frequently, beginning feeding on the less sore nipple, not allowing the infant to chew on the nipple or to sleep holding the nipple in the mouth, and applying tea bags soaked in warm water to the nipple. The remaining options are incorrect statements.
Question 3 of 5
A client with type 2 diabetes is admitted with a blood glucose level of 450 mg/dL. The nurse should anticipate which of the following orders?
Correct Answer: A
Rationale: Hyperglycemia requires regular insulin IV to rapidly lower blood glucose. Metformin is oral and slower, glucagon raises glucose, and potassium is not indicated without further assessment.
Question 4 of 5
A client with a history of ulcerative colitis is prescribed sulfasalazine (Azulfidine). The nurse should instruct the client to:
Correct Answer: B
Rationale: Sulfasalazine can cause photosensitivity, so clients should avoid sun exposure.
Question 5 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.