NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
A client with heart failure is prescribed spironolactone (Aldactone). The nurse should monitor for which of the following electrolyte imbalances?
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic, increasing the risk of hyperkalemia. Hypokalemia is associated with loop diuretics, and hyponatremia or hypercalcemia are less likely.
Question 2 of 5
While preparing a client for surgery, the nurse assesses for psychosocial problems that may cause preoperative anxiety. Which of the following is believed to be the most distressing fear a preoperative client is likely to experience?
Correct Answer: A
Rationale: Fear of the unknown is often the most distressing preoperative fear, as uncertainty about the procedure and outcome heightens anxiety.
Question 3 of 5
After a child returns from the postanesthesia care unit after surgery, which of the following should the nurse assess first?
Correct Answer: B
Rationale: Assessing pain first ensures the child's comfort and guides further care, as pain can affect recovery and other assessments.
Question 4 of 5
A nurse is caring for a toddler who is assessed as having hypertonicity, delayed fine motor skills, and poor control of coordinated motion. This is indicative of what cerebral palsy (CP) classification? Select all that apply.
Correct Answer: C,E
Rationale: Spastic cerebral palsy is characterized by hypertonicity and poor coordination. Abnormal involuntary or wormlike movements suggest dyskinetic CP, and gross motor impairment is not specified here.
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.