NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 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 2 of 5
A nurse is caring for a client who is having an allergic reaction to a blood transfusion. In what order should the nurse provide care for this client?
Order the Items
Source Container
Correct Answer: A,C,D
Rationale: The correct order is: 1) Stop the transfusion to halt the reaction, 2) Keep the vein open with saline to maintain access, 3) Administer antihistamine to manage symptoms, and 4) Send the blood bag to the blood bank for analysis.
Question 3 of 5
A client with a history of hypothyroidism is admitted with myxedema coma. The nurse should prioritize which of the following interventions?
Correct Answer: A
Rationale: Intravenous levothyroxine is the priority to correct severe hypothyroidism in myxedema coma.
Question 4 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 5 of 5
The nurse instructs a client who is taking iron supplements that:
Correct Answer: A
Rationale: Iron supplements are best absorbed on an empty stomach to maximize efficacy.