NCLEX Questions, NCLEX Trainer Test 4 Questions, NCLEX-PN Questions, Nurselytic

Questions 157

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Extract:


Question 1 of 5

A baby girl is born with a meningomyelocele. To prevent trauma to the sac, the nurse should place the infant:

Correct Answer: B

Rationale: Placing the infant prone with hips slightly elevated protects the meningomyelocele sac from trauma and pressure.

Question 2 of 5

After 4 electroconvulsive treatments over 2 weeks, a client is very upset and states 'I am so confused. I lose my money. I just can't remember telephone numbers.' The most therapeutic response for the nurse to make is

Correct Answer: D

Rationale: Communicating caring and empathy with the acknowledgement of feelings is the initial response. Afterwards, teaching about the expected short-term effects would be discussed.

Extract:

The nurse is teaching a client how to perform self-monitoring blood glucose (SMBG) using a blood glucose monitor.


Question 3 of 5

Which of the following actions, if performed by the client, indicates to the nurse the need for further teaching?

Correct Answer: D

Rationale: Strategy: 'Further teaching' indicates an incorrect response. (1) helps to facilitate venous congestion (2) less painful than the center of the fingertip (3) blood should sit on the strip like a raindrop, smearing alters the reading (4) correct-forces interstitial fluid to mix with capillary blood and dilutes the blood

Extract:


Question 4 of 5

During the admission assessment on a client with chronic bilateral glaucoma, which statement by the client would the nurse anticipate since it is associated with this problem?

Correct Answer: C

Rationale: I have to turn my head to see my room. Intraocular pressure becomes elevated, producing a progressive loss of the peripheral visual field in the affected eye.

Question 5 of 5

The nurse is caring for a client who is receiving a continuous IV infusion of insulin for diabetic ketoacidosis. Which of the following findings would be of GREATest concern to the nurse?

Correct Answer: B

Rationale: Hypokalemia (potassium 3.0 mEq/L) is a serious complication in diabetic ketoacidosis treatment, as insulin drives potassium into cells, risking arrhythmias. Options A, C, and D are less urgent: glucose 200 mg/dL is improving, pH 7.30 is near normal, and sodium 135 mEq/L is normal.

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