NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
When assessing a child receiving tobramycin sulfate (Nebcin), which findings would indicate that the child is experiencing adverse effects? Select all that apply.
Correct Answer: C, E
Rationale:
Tobramycin, an aminoglycoside, can cause nephrotoxicity (indicated by weight gain from fluid retention), ototoxicity (ringing in the ears), and allergic reactions (rash). Fever, increased blood pressure, and decreased heart rate are not typical adverse effects.
Question 2 of 5
A client with a history of Addison's disease is prescribed hydrocortisone (Cortef). The nurse should instruct the client to:
Correct Answer: C
Rationale: Hydrocortisone suppresses immunity, so reporting signs of infection is critical in Addison's disease.
Question 3 of 5
A client with a history of heart failure is prescribed furosemide (Lasix). The nurse should monitor the client for which of the following electrolyte imbalances?
Correct Answer: A
Rationale: Furosemide causes potassium loss, leading to hypokalemia, which requires monitoring.
Question 4 of 5
The nurse is making rounds and observes a client who is unconscious (see fi gure). The nursing assistant has just turned the client from lying on her back. Before raising the side rail, the nurse should:
Correct Answer: C
Rationale: The client is positioned correctly in the side-lying position. The pillows support the client’s joints and do not cause unnecessary pressure on the joints or skin. It is not necessary to add another pillow under the arm or to elevate the head of the bed. The nurse should assess the client’s skin for signs of breakdown, particularly at the elbows, back, hips, and heels where there were pressure points from the position in which the client was previously lying.
Question 5 of 5
A 3-month-old is admitted to the pediatric unit with moderate dehydration. The nurse should assess the client for:
Correct Answer: B, C
Rationale: Moderate dehydration in an infant is indicated by a rapid, thready pulse and decreased skin elasticity due to fluid loss.