NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
A nurse is caring for a child with diabetes mellitus at camp. The child is irritable and has a headache. Which of the following should the nurse do first?
Correct Answer: C
Rationale: Checking the blood glucose level determines whether the symptoms are due to hypo- or hyperglycemia, guiding treatment.
Question 2 of 5
A client with a diagnosis of rheumatoid arthritis is prescribed tofacitinib (Xeljanz). The nurse should monitor the client for which of the following side effects?
Correct Answer: A
Rationale:
Tofacitinib, a JAK inhibitor, increases the risk of infections due to immune suppression.
Question 3 of 5
The nurse is assessing fetal position in a 32-year-old woman in her eighth month of pregnancy. From the fi gure below, the fetal position can be described as:
Correct Answer: D
Rationale: In right occipital anterior lie, the occiput faces the right anterior segment of the woman’s pelvis. In left occipital transverse lie, the occiput faces the woman’s left hip. In left occipital anterior lie, the occiput faces the left anterior segment of the woman’s pelvis. In right occipital transverse lie, the occiput faces the woman’s right hip.
Question 4 of 5
A client has been given a prescription to begin using nitroglycerin transdermal medication patches. The nurse instructs the client about this medication administration system and provides which information? Select all that apply.
Correct Answer: B,C
Rationale: Nitroglycerin is a coronary vasodilator used in the management of coronary artery disease. The client is generally advised to apply a new medication patch each morning and leave it in place for 12 to 16 hours as the primary health care provider prescribes. The client needs the medication patch applied daily, not every 7 days, to ensure proper dosing is released as prescribed by the primary health care provider. The client can apply a new medication patch if it becomes dislodged because the dose is released continuously in small amounts through the skin. The client should avoid placing the medication patch in skinfolds or excoriated areas for appropriate absorption.
Question 5 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.