NCLEX-RN
NCLEX RN Question Bank Free Questions
Extract:
Question 1 of 5
A client with type 1 diabetes mellitus is admitted with hyperglycemia. The nurse should assess the client for which of the following signs of diabetic ketoacidosis (DKA)? Select all that apply.
Correct Answer: A, B, D, E
Rationale: DKA presents with fruity breath (due to acetone), Kussmaul respirations (compensatory hyperventilation), polyuria (osmotic diuresis), and hypotension (dehydration). Bradycardia is not typical.
Question 2 of 5
The mother of a neonate delivered at 36 weeks' gestation asks why the neonate is being treated for sepsis when no infection is present. Which of the following responses by the nurse is most appropriate?
Correct Answer: C
Rationale: Treating a 36-week neonate for sepsis is often precautionary due to their increased risk of infection, even without confirmed infection, to prevent complications.
Question 3 of 5
The nurse is evaluating the effectiveness of antimicrobial therapy for a client diagnosed with infective endocarditis. The nurse determines that which finding is the least reliable indicator of effectiveness?
Correct Answer: B
Rationale: A systolic heart murmur, once present in the client, will not resolve spontaneously and is therefore the least reliable indicator. Clear breath sounds are a normal finding, and in this instance could mean resolution of heart failure, if that was accompanying the endocarditis. Negative blood cultures and normothermia indicate resolution of infection.
Question 4 of 5
When a child is able to grasp the idea that a ball continues to exist even though his parent placed the ball under a hat, the child is in which of the following stages in the development of logical thinking, according to Piaget?
Correct Answer: A
Rationale: Object permanence, understanding that objects exist when out of sight, develops during the sensorimotor stage (birth to 2 years) per Piaget's theory.
Question 5 of 5
The nurse is caring for a client with a history of deep vein thrombosis (DVT). Which of the following laboratory values should the nurse monitor?
Correct Answer: A, D
Rationale: aPTT monitors heparin therapy, and D-dimer indicates clot presence in DVT.