NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
The nurse observes that a client who has received midazolam (Versed) for local anesthesia is having shallow respirations. The nurse should:
Correct Answer: C
Rationale: Midazolam can cause respiratory depression, so administering oxygen as ordered is the most appropriate initial response.
Question 2 of 5
A nurse is caring for a child with diabetes mellitus at camp. The child is irritable and has a headache. Which of the following should the nurse do first?
Correct Answer: C
Rationale: Checking the blood glucose level determines whether the symptoms are due to hypo- or hyperglycemia, guiding treatment.
Question 3 of 5
A client has a prescription to take magnesium citrate to prevent constipation after upper and lower gastrointestinal (GI) barium studies. The nurse tells the client that which is the best way to take this medication?
Correct Answer: D
Rationale: Magnesium citrate is available as an oral solution. It is commonly used as a laxative after certain studies of the GI tract. It should be served chilled and taken with a full glass of water. It should not be allowed to stand for prolonged periods. Allowing the medication to stand would reduce the carbonation and make the solution even less palatable. The remaining options are incorrect.
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
The nurse is planning to complete the following assessments during the last half hour of the shift. Which of the following assessments has the highest priority and should be accomplished first?
Correct Answer: A
Rationale: The infant with transient tachypnea of the newborn (TTN) and a respiratory rate of 60 breaths/minute indicates potential respiratory distress, which is a life-threatening condition requiring immediate assessment.