NCLEX-RN
NCLEX RN High-Yield Questions Questions
Extract:
Question 1 of 5
When teaching a client with bipolar disorder, mania, who has started to take valproic acid (Depakene) about possible side effects of this medication, the nurse should include which of the following in the teaching plan?
Correct Answer: C
Rationale: Valproic acid commonly causes sedation as a side effect, which the client should be aware of to manage daily activities safely.
Question 2 of 5
The nurse is administering a subcutaneous injection of heparin. Which technique ensures safe administration?
Correct Answer: D
Rationale: Pinching the skin creates a fold for subcutaneous injection, ensuring heparin is delivered into the correct tissue layer without damaging underlying structures.
Question 3 of 5
While assessing a neonate at age 24 hours, the nurse observes several irregularly shaped, red, flat patches on the back of the neonate's neck. The nurse interprets this finding as which of the following?
Correct Answer: A
Rationale: Stork bites are common, benign, red, flat patches on a neonate's neck or face that typically fade over time. Port wine stains are darker and persistent, newborn rash is more generalized, and café au lait spots are pigmented and light brown.
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 nurse is caring for a client who is having an allergic reaction to a blood transfusion. In what order should the nurse provide care for this client?
Order the Items
Source Container
Correct Answer: A,C,D
Rationale: The correct order is: 1) Stop the transfusion to halt the reaction, 2) Keep the vein open with saline to maintain access, 3) Administer antihistamine to manage symptoms, and 4) Send the blood bag to the blood bank for analysis.