NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
The CRIES scale is used to:
Correct Answer: D
Rationale: The CRIES scale is a neonatal pain assessment tool used to evaluate pain based on crying, oxygen requirement, vital signs, facial expression, and sleeplessness.
Question 2 of 5
Select the risk factor that is accurately paired with its disorder.
Correct Answer: C
Rationale: Hyperkalemia is associated with ketoacidosis, as metabolic acidosis can cause potassium to shift out of cells, elevating serum levels.
Question 3 of 5
A client with heart failure is prescribed spironolactone (Aldactone). The nurse should monitor for which of the following electrolyte imbalances?
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic, increasing the risk of hyperkalemia. Hypokalemia is associated with loop diuretics, and hyponatremia or hypercalcemia are less likely.
Question 4 of 5
The nurse assesses a client who is receiving a tube feeding. Which of the following situations would require prompt intervention from the nurse?
Correct Answer: B
Rationale: A feeding hanging for 8 hours poses an infection risk due to bacterial growth, requiring prompt intervention.
Question 5 of 5
A 2-month-old infant is brought to the clinic with a fever of 101°F (38.3°C). What should the nurse instruct the parents to do first?
Correct Answer: C
Rationale: A fever in a 2-month-old is a medical emergency due to the risk of serious bacterial infection. Immediate medical attention is required.