Questions 150

NCLEX-RN

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Question 1 of 5

A client returning from the postanesthesia care unit after transurethral resection of the prostate (TURP) has bladder irrigation running via a 3-way Foley catheter. The nurse should notify the primary health care provider if which color of urine is noted in the urinary drainage bag?

Correct Answer: B

Rationale: Bright red bleeding should be reported because it could indicate complications related to active bleeding. If the bladder irrigation is infusing at a sufficient rate, the urinary drainage will be pale pink. A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation should be increased. Tea-colored urine is not seen after TURP but may be noted in the client with renal failure or other renal disorders.

Question 2 of 5

A primiparous client who is breast-feeding develops endometritis on the third postpartum day. Which of the following instructions should the nurse give to the mother?

Correct Answer: B

Rationale: Endometritis is typically treated with I.V. antibiotics to address the infection.

Question 3 of 5

Which of the following baseline laboratory data should be established before a client is started on tissue plasminogen activator or alteplase recombinant (Activase)?

Correct Answer: C

Rationale: These tests assess bleeding risk, critical before administering thrombolytics like alteplase, which can cause hemorrhage.

Question 4 of 5

The nurse is teaching a client who is taking cyclosporine after renal transplant about medication information. The nurse should tell the client to be especially alert for which problem?

Correct Answer: D

Rationale: Cyclosporine is an immunosuppressant medication used to prevent transplant rejection. The client should be especially alert for signs and symptoms of infection while taking this medication and report them to the primary health care provider if experienced. The client is also taught about other side/adverse effects of the medication, including hypertension, increased facial hair, tremors, gingival hyperplasia, and gastrointestinal complaints. Some weight loss may occur, but this is not as significant as the onset of an infection.

Question 5 of 5

The mother of a 7-month-old child born 6 weeks early asks the nurse what play activities and toys are appropriate for her child. Which of the following should the nurse suggest?

Correct Answer: B

Rationale: Peek-a-boo is an age-appropriate activity for a 7-month-old, promoting social and cognitive development. Picture books and colored blocks are better for older children, and a rattle may be less engaging for this age.

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