NCLEX-RN
NCLEX RN Practice Questions Quizlet
1. When administering a shot of Vitamin K to a 30-day-old infant, which of the following target areas is the most appropriate?
- A. Gluteus maximus
- B. Gluteus minimus
- C. Vastus lateralis
- D. Vastus medialis
Correct answer: C
Rationale: When administering medications to infants, it is common to use the vastus lateralis muscle in the thigh for injections. The preferred site is the junction of the upper and middle thirds of the vastus lateralis muscle. This area provides a good muscle mass for the injection and minimizes the risk of hitting nerves or blood vessels. The gluteus maximus and gluteus minimus are not typically used for infant injections due to the risk of injury to the sciatic nerve. The vastus medialis is not as commonly used as the vastus lateralis for infant injections.
2. A 3-year-old had a hip spica cast applied 2 hours ago. In order to facilitate drying, the nurse should:
- A. Expose the cast to air and turn the child frequently.
- B. Use a heat lamp to reduce the drying time.
- C. Handle the cast with the abductor bar.
- D. Turn the child as little as possible.
Correct answer: A
Rationale: After a hip spica cast is applied, it is important to facilitate drying by exposing the cast to air and turning the child frequently, approximately every 2 hours. This helps ensure even drying and prevents skin breakdown. Using a heat lamp can cause burns and should be avoided. Handling the cast with the abductor bar is not necessary for the drying process and may cause discomfort to the child. Turning the child as little as possible is not recommended as regular turning helps prevent complications like pressure ulcers and stiffness.
3. When reading a lab report, you notice that a patient's sample is described as having anisocytosis. Which of the following most accurately describes the patient's condition?
- A. The patient has an abnormal condition of skin cells.
- B. The patient's red blood cells vary in size.
- C. The patient has a high level of fat cells and is obese.
- D. The patient's cells are indicative of necrosis.
Correct answer: B
Rationale: Anisocytosis is a term that indicates variation in the size of red blood cells. When a patient is described as having anisocytosis, it means their red blood cells exhibit differences in size. This condition can be detected in blood samples and may indicate underlying blood disorders. The other choices are incorrect: Choice A refers to a skin cell condition, Choice C relates to obesity and fat cells, and Choice D suggests necrosis, none of which are associated with anisocytosis or red blood cell abnormalities. It is important to recognize specific terms like anisocytosis in laboratory reports to understand the potential implications for the patient's health.
4. Which of the following is TRUE about shock?
- A. A patient with severe shock does not always have an abnormally low blood pressure.
- B. Confusion and deteriorating mentation are indicative of hypotensive shock.
- C. Patients with compensated shock may not be able to maintain a normal blood pressure.
- D. A normal blood pressure does not imply that the patient is stable.
Correct answer: B
Rationale: Confusion and deteriorating mentation are indeed indicative of hypotensive shock. It is important to note that a patient with hypotensive shock will likely exhibit deteriorating mental status. Choice A is incorrect because a patient in severe shock may not always have an abnormally low blood pressure, making it an unreliable indicator of shock severity. Choice C is incorrect because patients with compensated shock may present with normal blood pressure but still have inadequate tissue perfusion. Choice D is incorrect because a normal blood pressure does not guarantee the patient's stability, especially in cases of shock where tissue perfusion may be compromised despite normal blood pressure readings.
5. You are responsible for reviewing the nursing unit's refrigerator. Which of the following drugs, if found inside the fridge, should be removed?
- A. Nadolol (Corgard)
- B. Opened (in-use) Humulin N injection
- C. Urokinase (Kinlytic)
- D. Epoetin alfa IV (Epogen)
Correct answer: A
Rationale: Nadolol (Corgard) should be removed if found inside the fridge because it is supposed to be stored at room temperature between 59 to 86 �F (15 and 30 �C) away from heat, moisture, and light. Storing it in the refrigerator can alter its effectiveness and stability. Option B, the opened Humulin N injection, should not be stored in the refrigerator as it is an in-use product and can remain at room temperature for a certain period as per manufacturer guidelines. Option C, Urokinase (Kinlytic), and Option D, Epoetin alfa IV (Epogen), do not require refrigeration and can be stored at room temperature. Therefore, Nadolol (Corgard) is the drug that should be removed from the fridge.
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