NCLEX-RN
NCLEX RN Nursing Exam Questions
Extract:
Question 1 of 5
The physician has diagnosed a client with cirrhosis characterized by asterixis. If the nurse assesses the client with asterixis, he can expect to find:
Correct Answer: A
Rationale: Asterixis, a flapping tremor of the wrists when extended, is a sign of hepatic encephalopathy in cirrhosis due to ammonia buildup. The other findings are unrelated to asterixis.
Question 2 of 5
A client tells the nurse that she takes St. John's wort (hypericum perforatum) three times a day for mild depression. The nurse should tell the client that:
Correct Answer: C
Rationale: St. John's wort increases photosensitivity, so sunscreen use may paradoxically increase skin reactions; clients should be cautioned about sun exposure.
Question 3 of 5
A client on a mechanical ventilator begins to fight the ventilator. Which medication will be ordered for the client?
Correct Answer: B
Rationale: Pancuronium bromide, a neuromuscular blocker, paralyzes muscles to prevent fighting the ventilator, ensuring effective ventilation. Sedatives like midazolam or fentanyl are secondary.
Question 4 of 5
The client with a history of heart failure is prescribed spironolactone (Aldactone). The nurse should monitor for which potential side effect?
Correct Answer: B
Rationale: Spironolactone, a potassium-sparing diuretic, can cause hyperkalemia by reducing potassium excretion. Hypokalemia is caused by other diuretics, hypoglycemia is unrelated, and spironolactone lowers blood pressure.
Question 5 of 5
The physician orders fluoxetine (Prozac) for a depressed client. Which of the following should the nurse remember about fluoxetine?
Correct Answer: B
Rationale: Fluoxetine is not a tricyclic antidepressant. It is an atypical antidepressant. This statement is true. These foods are high in tyramine and should be avoided when the client is taking MAO inhibitors. Fluoxetine is not an MAO inhibitor. Fatal reactions have been reported in clients receiving fluoxetine in combination with MAO inhibitors.