NCLEX-RN
NCLEX RN SATA Questions Questions
Extract:
Question 1 of 5
Which actions should the nurse implement to prevent ventilator-associated pneumonia (VAP) in the client who is intubated and on mechanical ventilation?
Correct Answer: A
Rationale: Because normal upper airway defenses are bypassed, clients who are intubated with mechanical ventilation are at risk for VAP. Prevention includes effective hand washing before and after suctioning, when touching ventilator equipment, and when in contact with respiratory secretions.
To prevent aspiration of colonized secretions from the oral cavity, the client will need more frequent oral cavity suctioning and at least 30 degrees head of the bed elevation. The more frequently the circuit is broken, the greater the risk for pathogen entry.
Question 2 of 5
A client has been given a prescription to begin using nitroglycerin transdermal patches. The nurse instructs the client about this medication administration system and tells the client to expect which side effect?
Correct Answer: B
Rationale: Nitroglycerin is a coronary vasodilator used in the management of coronary artery disease. A common side effect of this medication is an intense headache. Clients should be instructed about this side effect and that acetaminophen can be helpful in alleviating discomfort. The remaining options are not associated with the use of this medication.
Question 3 of 5
A client with a history of ulcerative colitis is prescribed sulfasalazine (Azulfidine). The nurse should instruct the client to:
Correct Answer: B
Rationale: Sulfasalazine can cause photosensitivity, so clients should avoid sun exposure.
Question 4 of 5
The clinic nurse is reviewing the laboratory reports for a client who is taking allopurinol (Zyloprim). Which of the following laboratory findings indicates that the allopurinol is having the desired effect?
Correct Answer: A
Rationale: Allopurinol reduces serum uric acid levels by inhibiting xanthine oxidase, which is its therapeutic effect in treating gout.
Question 5 of 5
The nurse is teaching a client with a new diagnosis of hyperthyroidism about medication management. Which of the following medications should the client expect to take?
Correct Answer: A, D
Rationale: Methimazole and propylthiouracil inhibit thyroid hormone production in hyperthyroidism.