NCLEX-RN
NCLEX RN High-Yield Questions Questions
Question 1 of 5
A client's chest tube is connected to a drainage system with a water seal. The nurse notes that the fluid in the water-seal column is fluctuating with each breath that the client takes. The fluctuation means that:
Correct Answer: C
Rationale: Fluctuation in the water-seal column with breathing indicates the chest tube is patent and functioning correctly, reflecting intrathoracic pressure changes.
Question 2 of 5
The nurse is caring for a client who has experienced severe multiple trauma. The client's arterial blood gases reveal low arterial oxygen levels that are not responsive to high concentrations of oxygen. The nurse is aware that this finding is a major indicator of the development of which of the following conditions?
Correct Answer: C
Rationale: Low arterial oxygen levels unresponsive to high oxygen concentrations are indicative of ARDS, often seen in severe trauma due to lung injury. Pneumonia, shock, and asthma present differently.
Question 3 of 5
The nurse teaches the client with cirrhosis that he is achieving the expected effect of lactulose (Cephulac) when he has:
Correct Answer: B
Rationale: Lactulose is used in cirrhosis to reduce ammonia levels by promoting 2–3 soft stools per day. Fewer or more frequent stools may indicate under- or overdosing.
Question 4 of 5
A client previously well controlled with glyburide has recently begun reporting fasting blood glucose to be 180 to 200 mg/dL (10.28-11.42 mmol/L). Which medication, noted in the client's record, may be contributing to the elevated blood glucose level?
Correct Answer: A
Rationale: Corticosteroids, thiazide diuretics, and lithium may decrease the effect of glyburide, causing hyperglycemia. All the other options may increase the effect of glyburide, leading to hypoglycemia.
Question 5 of 5
A postmastectomy client has been found to have an estrogen receptor-positive tumor. The nurse interprets after reading this information in the pathology report that the client will most likely have which common follow-up treatment prescribed?
Correct Answer: C
Rationale: A common treatment for women with estrogen receptor-positive breast tumors is follow-up treatment with tamoxifen. This medication is classified as an antineoplastic agent and competes with estrogen for binding sites in the breast and other tissues. The medication may be administered for years after surgery. The remaining options suggest incorrect treatments.