NCLEX-RN
NCLEX RN Practice Questions Questions
Extract:
Question 1 of 5
The nurse is caring for a client with staphylococcus epidermidis. The client is on a vancomycin IV. What nursing consideration should the nurse be aware of regarding this medication?
Correct Answer: C
Rationale: Vancomycin requires monitoring trough levels (drawn before a dose) to ensure therapeutic efficacy and prevent toxicity.
Question 2 of 5
The nurse is caring for an unvaccinated child who developed complications related to German measles (rubella). Which of the following infection control protocols is appropriate?
Correct Answer: C
Rationale: Rubella is transmitted via respiratory droplets, requiring standard and droplet precautions (
C). Contact (
B) and airborne (
D) precautions are not indicated for rubella.
Question 3 of 5
The mother of a 1-year-old with sickle cell anemia wants to know why the condition didn't show up in the nursery. The nurse's response is based on the knowledge that:
Correct Answer: D
Rationale: Fetal hemoglobin, present in newborns, inhibits sickling, masking sickle cell anemia symptoms until fetal hemoglobin decreases after several months.
Question 4 of 5
When caring for a ventilator-dependent client who is receiving tube feedings, the nurse can help prevent aspiration of gastric secretions by:
Correct Answer: B
Rationale: Elevating the head of the bed 30-45° reduces the risk of aspiration in ventilator-dependent clients.
Question 5 of 5
A client with hyperkalemia is admitted to the telemetry unit. Which of the following would require notification of the health care provider? Select all that apply.
Correct Answer: A, B
Rationale: Spiked T waves and bradycardia (heart rate 53) are signs of severe hyperkalemia, requiring immediate provider notification. Normal heart rate, food refusal, and adequate urinary output (30 cc/hr) are not urgent.