NCLEX-RN
NCLEX RN SATA Questions Questions
Extract:
Question 1 of 5
The nurse assesses a client and notes puffy eyelids, swollen ankles, and crackles at both lung bases. The nurse understands that these clinical findings are most specifically associated with fluid excess in which of the following compartments?
Correct Answer: C
Rationale: These symptoms indicate fluid excess in the extracellular compartment, which includes interstitial spaces (edema) and intravascular spaces (contributing to lung crackles).
Question 2 of 5
A nurse is preparing to administer 500 mL of an I.V. solution to a child over 12 hours via tubing that delivers microdrips at 60 gtt/mL. At what rate should the nurse infuse the solution?
Correct Answer: A
Rationale: Calculate: 500 mL over 12 hours = 41.67 mL/hour. For microdrip (60 gtt/mL), 41.67 mL/hour ×60 gtt/mL = 2500 gtt/hour ÷ 60 minutes = 41.67 gtt/minute, rounded to 42 gtt/minute.
Question 3 of 5
Sulfadiazine has been ordered for a client who has a urinary tract infection. Which of the following recommend is most appropriate for administering sulfonamides?
Correct Answer: B
Rationale: Adequate hydration (8 glasses of water daily) prevents crystalluria, a complication of sulfonamides.
Question 4 of 5
Which of the following assessment finding is expected in a client with bacterial pneumonia?
Correct Answer: A
Rationale: Increased fremitus is expected in bacterial pneumonia due to lung consolidation.
Question 5 of 5
The nurse is assessing a client with irreversible shock. The nurse should document which of the following?
Correct Answer: B
Rationale: Irreversible shock is characterized by circulatory collapse, with failure of vital organs due to inadequate perfusion, a critical finding to document.