NCLEX-RN
NCLEX RN Questions with Detailed Explanations Questions
Extract:
Question 1 of 5
For which of the following should the nurse be especially alert when caring for a term neonate, who weighed 10 lb at birth, 1 hour after a vaginal delivery?
Correct Answer: A
Rationale: The neonate would be considered large for gestational age (LG
A) because the neonate weighs more than 4,000 g (90th percentile). Hypoglycemia is a problem for the LGA neonate because glycogen stores are quickly used to maintain the weight. Other complications like hyperbilirubinemia may occur, but hypoglycemia is the priority concern within the first hour.
Question 2 of 5
The nurse is caring for a client with a history of Crohn's disease who is prescribed mesalamine (Asacol). The nurse should instruct the client to report which of the following side effects immediately?
Correct Answer: C
Rationale: Fever may indicate an exacerbation of Crohn's disease or a side effect of mesalamine, requiring immediate reporting.
Question 3 of 5
A client who has Ménière's disease is experiencing an acute attack of vertigo. Which of the following interventions should the nurse include in the plan of care?
Correct Answer: A
Rationale: A dark, quiet environment reduces stimuli that can exacerbate vertigo in Ménière's disease.
Question 4 of 5
A client has primary health care provider instructions to take ibuprofen 0.4 g for mild pain. The medication bottle contains ibuprofen 200-mg tablets. How many tablets will the nurse instruct the client to take for each dose? Fill in the blank. tablets
Correct Answer: 2
Rationale:
To determine the number of tablets, divide the prescribed dose by the strength per tablet: 0.4 g = 400 mg; 400 mg ÷ 200 mg per tablet = 2 tablets.
Therefore, the nurse instructs the client to take 2 tablets per dose.
Question 5 of 5
A client diagnosed with valvular heart disease is at risk for developing heart failure. What should the nurse assess as the priority when monitoring for heart failure?
Correct Answer: B
Rationale: Breath sounds are the best way to assess for the onset of heart failure. The presence of crackles or an increase in crackles is an indicator of fluid in the lungs caused by heart failure. The remaining options are components of the assessment but are less reliable indicators of heart failure.