NCLEX Questions, ATI NCLEX-RN Practice Questions Questions, NCLEX-RN Questions, Nurselytic

Questions 158

NCLEX-RN

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Extract:


Question 1 of 5

A 5-year-old has just had a tonsillectomy and adenoidectomy. Which of these nursing measures should be included in the postoperative care?

Correct Answer: D

Rationale: The nurse should discourage the child from coughing, clearing the throat, or putting objects in his mouth. These may induce bleeding. Cool, clear liquids may be given when child is fully alert. Warm liquids may dislodge a blood clot. The nurse should avoid red- or brown-colored liquids to distinguish fresh or old blood from ingested liquid should the child vomit. Gargles and vigorous toothbrushing could initiate bleeding. Postoperative hemorrhage, though unusual, may occur. The nurse should observe for bleeding by looking directly into the throat and for vomiting of bright red blood, continuous swallowing, and changes in vital signs.

Question 2 of 5

The nurse is teaching a client with a history of hypertension about lifestyle modifications. The nurse should tell the client to:

Correct Answer: A

Rationale: Reducing stress lowers blood pressure in hypertension, improving cardiovascular health.

Question 3 of 5

In the coronary care unit, a client has developed multifocal premature ventricular contractions. The nurse should anticipate the administration of:

Correct Answer: C

Rationale: Lidocaine is the drug of choice to treat ectopic ventricular beats.

Question 4 of 5

The nurse has just received the change of shift report. Which client should the nurse assess first?

Correct Answer: A

Rationale: The client two hours post-lobectomy with 150mL of chest drainage is at risk for complications such as hemorrhage or tension pneumothorax, requiring immediate assessment. The other clients are stable: scant drainage is expected post-gastrectomy, a fever in pneumonia is concerning but less urgent, and a fractured hip in traction is typically stable.

Question 5 of 5

Succinylcholine chloride (Anectine) is ordered prior to electroconvulsive therapy treatment for depressed clients. The nurse explains that the purpose of the drug is to:

Correct Answer: A

Rationale: Succinylcholine chloride relaxes muscles and decreases the intensity of the seizure during electroconvulsive therapy.

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