Questions 158

NCLEX-RN

NCLEX-RN Test Bank

RN NCLEX Practice Test Questions

Question 1 of 5

The mother of a child taking phenytoin will need to plan appropriate mouth care and gingival stimulation. When tooth-brushing is contraindicated, the next most effective cleansing and gingival stimulation technique would be:

Correct Answer: A

Rationale: This technique provides effective rinsing and gingival stimulation. This technique does not provide gingival stimulation. This technique provides effective rinsing but not gingival stimulation. Using peroxide is not pleasant for the child. This technique provides effective rinsing but not gingival stimulation.

Question 2 of 5

A client with a renal failure is prescribed a low potassium diet. Which food choice would be best for this client?

Correct Answer: D

Rationale: A low potassium diet is essential for clients with renal failure to prevent hyperkalemia. Among the options, 1 cup of rice has the lowest potassium content (approximately 50–100 mg per cup), making it the best choice. Beef broth contains moderate potassium (around 200 mg per cup), a baked potato with skin is high in potassium (about 900 mg), and raisins are also high (around 500 mg per half cup).

Question 3 of 5

A client's transfusion of packed red blood cells has been infusing for 2 hours. She is complaining of a raised, itchy rash and shortness of breath. She is wheezing, anxious, and very restless. The nurse knows these assessment findings are congruent with:

Correct Answer: D

Rationale: A hemolytic transfusion reaction would be characterized by fever, chills, chest pain, hypotension, and tachypnea. Fever, chills, and headaches are indicative of a febrile transfusion reaction. Circulatory overload is manifest by dyspnea, cough, and pulmonary crackles. Urticaria, pruritus, wheezing, and anxiety are indicative of an allergic transfusion reaction.

Question 4 of 5

A client with a history of atrial fibrillation is admitted with complaints of fatigue. The nurse should give priority to:

Correct Answer: A

Rationale: Fatigue in atrial fibrillation may indicate reduced cardiac output, so monitoring heart rate is the priority.

Question 5 of 5

The client with a history of gout is prescribed allopurinol (Zyloprim). The nurse should instruct the client to:

Correct Answer: B

Rationale: Allopurinol reduces uric acid production, and taking it with a full glass of water promotes excretion of uric acid, preventing kidney stones. Fluid restriction is harmful, calcium is not restricted, and it can be taken with food.

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