NCLEX-RN
NCLEX RN Predictor Exam Questions
Extract:
Question 1 of 5
A nurse is administering a blood transfusion to a client on the oncology unit. Which clinical manifestation indicates an acute hemolytic reaction to the blood?
Correct Answer: A
Rationale: Low back pain is a hallmark of acute hemolytic reaction due to immune-mediated hemolysis. Headache (
B) and urticaria (
C) suggest allergic reactions, and neck vein distention (
D) suggests fluid overload.
Question 2 of 5
A male client is experiencing auditory hallucinations. His nurse enters the room and he tells her that his mother is talking to him, and he will take his medicine after she leaves. The nurse looks around the room and sees that she and the client are the only ones in the room. The nurse's most therapeutic response will be:
Correct Answer: A
Rationale: This response uses the principle of reality orientation by the nurse telling the client that he or she does not see anything, but it does recognize his feelings.
Question 3 of 5
The nurse is caring for a client with a history of hyperthyroidism. The nurse should expect the client to have:
Correct Answer: A
Rationale: Hyperthyroidism increases metabolism, leading to weight loss, heat intolerance, and tachycardia, a common clinical finding.
Question 4 of 5
A 75-year-old client is hospitalized with pneumonia caused by gram-positive bacteria. Which one of the following best describes a gram-positive bacterial pneumonia?
Correct Answer: B
Rationale: Klebsiella pneumonia is caused by gram-negative bacteria. Pneumococcal pneumonia is caused by gram-positive bacteria. Legionella pneumophila pneumonia is a nonbacterial pneumonia. E. coli pneumonia is caused by gram-negative bacteria.
Question 5 of 5
The nurse is caring for a client with leukemia who has received the drug Daunorubicin (Cerubidine). Which of the following common side effects would cause the most concern?
Correct Answer: C
Rationale: Cardiotoxicity, a serious side effect of Daunorubicin, can lead to heart failure and requires immediate attention. Nausea (
A), vomiting (
B), and alopecia (
D) are common but less life-threatening.