NCLEX-RN
Basic Adult Health Care NCLEX Questions Questions
Extract:
Question 1 of 5
Which is a priority assessment for the client in shock who is receiving an I.V. infusion of packed red blood cells and normal saline solution?
Correct Answer: B
Rationale: During a blood transfusion in a client in shock, the priority assessment is for an anaphylactic reaction, as transfusion reactions can be life-threatening and require immediate intervention. Fluid balance, pain, and consciousness are monitored but are secondary.
Question 2 of 5
A client who is to receive general anesthesia has a serum potassium level of 5.8 mEq/L. What should be the nurse's first response?
Correct Answer: D
Rationale: A potassium level of 5.8 mEq/L indicates hyperkalemia, which can cause cardiac complications under general anesthesia. Notifying the anesthesiologist first ensures prompt evaluation and management to ensure patient safety.
Question 3 of 5
Lifestyle influences that are considered risk factors for colorectal cancer include:
Correct Answer: C
Rationale: A high-fat, low-fiber diet is a well-established risk factor for colorectal cancer, as it slows digestion and increases exposure to potential carcinogens in the colon.
Question 4 of 5
If the client who was admitted for myocardial infarction (MI) develops cardiogenic shock, which characteristic sign should the nurse expect to observe?
Correct Answer: A
Rationale: Cardiogenic shock causes decreased cardiac output, leading to reduced renal perfusion and oliguria (low urine output). Bradycardia, elevated BP, and fever are not typical signs.
Question 5 of 5
Contraindications to the administration of tissue plasminogen activator (t-PA) include which of the following?
Correct Answer: B
Rationale: A history of cerebral hemorrhage is an absolute contraindication to t-PA due to the risk of bleeding. Age, heart failure, and smoking are not contraindications.