NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
A nurse is administering I.V. fluids to a dehydrated client. When administering an I.V. solution of 3% sodium chloride, what should the nurse do? Select all that apply.
Correct Answer: A,B,C
Rationale: 3% sodium chloride is hypertonic and requires monitoring of intake/output, jugular veins for fluid overload, and neurologic status for hypernatremia effects. Forcing fluids or catheterization is not indicated.
Question 2 of 5
When developing the plan of care for a client with Alzheimer's disease, which of the following activities is least beneficial to the client?
Correct Answer: D
Rationale: Stress management is least beneficial for Alzheimer's clients, as cognitive impairment limits their ability to engage in such activities. Reminiscence, walking, and pet therapy support engagement and well-being.
Question 3 of 5
The nurse is developing a plan of care for a client diagnosed with acquired immunodeficiency syndrome (AIDS). The nurse should document which goals for the client in the plan of care? Select all that apply.
Correct Answer: A,D
Rationale: A common, life-threatening opportunistic infection that occurs in clients with AIDS is Pneumocystis jiroveci pneumonia. Its symptoms include fever, exertional dyspnea, and nonproductive cough. The absence of respiratory distress and that of a fever are two of the goals that the nurse sets as priorities. The remaining options are not specifically related to AIDS.
Question 4 of 5
A client previously well controlled with glyburide has recently begun reporting fasting blood glucose to be 180 to 200 mg/dL (10.28-11.42 mmol/L). Which medication, noted in the client's record, may be contributing to the elevated blood glucose level?
Correct Answer: A
Rationale: Corticosteroids, thiazide diuretics, and lithium may decrease the effect of glyburide, causing hyperglycemia. All the other options may increase the effect of glyburide, leading to hypoglycemia.
Question 5 of 5
A client with newly diagnosed breast cancer asks the nurse why she needs to have chemotherapy after her breast was removed. Which of the following responses by the nurse is most appropriate?
Correct Answer: A
Rationale: Chemotherapy is used post-mastectomy to target any residual cancer cells, reducing the risk of recurrence.