NCLEX Questions, NCLEX Trainer Test 2 Questions, NCLEX-PN Questions, Nurselytic

Questions 157

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NCLEX Trainer Test 2 Questions

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Question 1 of 5

A client receiving Eskalith (lithium carbonate) has a level of 4.5 mEq/L. The nurse should prepare the client for immediate:

Correct Answer: B

Rationale: A lithium level of 4.5 mEq/L indicates severe toxicity, requiring hemodialysis to rapidly remove lithium from the body.

Question 2 of 5

At 10:00 A.M., the nurse discovers a 75-year-old woman who is hospitalized with congestive heart failure on the floor beside the bed. She has a bruise on her leg, but x-rays reveal no fractures. How should the nurse record the incident in the client's chart?

Correct Answer: B

Rationale: Accurate documentation includes specific details: time, client status, mechanism of fall, assessment findings (bruise size, orientation), and actions taken (physician notification, x-rays). This option is thorough and objective, unlike the others, which are vague or incomplete.

Question 3 of 5

A 48-year-old woman is diagnosed with a tumor of the pituitary gland and has a transsphenoidal hypophysectomy. The nurse plans care for the patient two days after surgery. It is MOST important for the nurse to monitor the patient's

Correct Answer: C

Rationale: Transsphenoidal hypophysectomy risks diabetes insipidus from ADH disruption, detected by low urine specific gravity. Options A, B, and D are less specific.

Extract:

A client in labor is receiving magnesium sulfate IV.


Question 4 of 5

Which assessment is MOST important to give during report to the nurse on the next shift?

Correct Answer: D

Rationale: Strategy: Determine how each answer choice relates to magnesium sulfate. (1) not a concern because the respirations are increasing (2) not relevant to the medication (3) not relevant to the medication (4) correct-magnesium sulfate is a central nervous system depressant; side effect is oliguria

Extract:


Question 5 of 5

Which one of the following rights is included in the Patient's Bill of Rights?

Correct Answer: C

Rationale: The Patient's Bill of Rights includes the right to confidentiality. Continuity, privacy, and advance directives are important but not explicitly listed as primary rights.

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