NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
The nurse is developing a plan of care for a client diagnosed with acquired immunodeficiency syndrome (AIDS). The nurse should document which goals for the client in the plan of care? Select all that apply.
Correct Answer: A,D
Rationale: A common, life-threatening opportunistic infection that occurs in clients with AIDS is Pneumocystis jiroveci pneumonia. Its symptoms include fever, exertional dyspnea, and nonproductive cough. The absence of respiratory distress and that of a fever are two of the goals that the nurse sets as priorities. The remaining options are not specifically related to AIDS.
Question 2 of 5
The nurse is watching two siblings, ages 7 and 9 years, verbally arguing over a toy. The nurse has discussed the parent before about how to handle this situation. The nurse should judge that the teaching has been effective when the parent does which of the following?
Correct Answer: B
Rationale: Ignoring minor verbal arguments allows children to resolve conflicts independently, as previously taught. Forcing handshakes or punishment escalates the situation unnecessarily.
Question 3 of 5
A client is admitted to the hospital in myasthenic crisis. The nurse should ask the client about which precipitating factor for this event?
Correct Answer: B
Rationale: Myasthenic crisis is often caused by undermedication and responds to the administration of cholinergic medications such as neostigmine and pyridostigmine. Increased sleep and change in diet are not precipitating factors. However, overexertion and overeating could possibly trigger myasthenic crisis. Cholinergic crisis is caused by excess medication and responds to withholding of medications.
Question 4 of 5
A nurse is administering I.V. fluids to a dehydrated client. When administering an I.V. solution of 3% sodium chloride, what should the nurse do? Select all that apply.
Correct Answer: A,B,C
Rationale: 3% sodium chloride is hypertonic and requires monitoring of intake/output, jugular veins for fluid overload, and neurologic status for hypernatremia effects. Forcing fluids or catheterization is not indicated.
Question 5 of 5
A client with a history of schizophrenia is prescribed risperidone (Risperdal). The nurse should monitor the client for which of the following adverse effects?
Correct Answer: A
Rationale: Risperidone can cause extrapyramidal symptoms, such as tremors and rigidity, requiring monitoring.