NCLEX Questions, NCLEX Trainer Test 1 Questions, NCLEX-PN Questions, Nurselytic

Questions 157

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Extract:


Question 1 of 5

A client admitted with a severe head injury following an MVA is placed on a ventilator, and hyperventilation is maintained. The primary reason for maintaining hyperventilation is:

Correct Answer: D

Rationale: Hyperventilation reduces $\mathrm{CO}_2$, causing cerebral vasoconstriction, which decreases cerebral blood flow and intracranial pressure in head injuries.

Question 2 of 5

The nurse is teaching a client with chronic kidney disease about dietary restrictions. Which of the following foods should the nurse advise the client to limit?

Correct Answer: C

Rationale: Potato chips are high in sodium and potassium, which must be limited in chronic kidney disease to prevent fluid retention and hyperkalemia. Options A, B, and D are more suitable: strawberries are low-potassium, chicken is protein-rich, and brown rice is acceptable in moderation.

Question 3 of 5

The nurse is to insert an indwelling catheter in a male. Which action is appropriate?

Correct Answer: B

Rationale: Washing hands before catheter insertion is critical to maintain a sterile field and prevent infection. Cleansing the meatus occurs after hand washing, a 45-degree angle is incorrect (90 degrees is typical), and the balloon is inflated post-insertion.

Question 4 of 5

A client hospitalized with acute glomerulonephritis has a positive ASO titer. The nurse understands that the client's current illness is due to a:

Correct Answer: B

Rationale: A positive antistreptolysin titer indicates infection with Group A β-hemolytic Streptococcus, a bacterial infection. Answers A, C, and D are not associated with acute glomerulonephritis so they are incorrect.

Extract:

A client with a temperature of 103°F (39.4°C).


Question 5 of 5

Body compensatory mechanisms would include which of the following?

Correct Answer: C

Rationale: Strategy: Think about each answer choice. (1) respirations and heart rate will increase with fever (2) blood pressure and pulse usually increase with fever (3) correct-hyperthermia increases the oxygen requirements, which results in faster breathing as well as an increase in the pulse rate (4) diaphoresis may occur, but the skin will be warm

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