NCLEX Questions, NCLEX RN Practice Questions Quizlet Questions, NCLEX-RN Questions, Nurselytic

Questions 149

NCLEX-RN

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Extract:


Question 1 of 5

A client with burns is admitted and fluid resuscitation has begun. Central venous pressure (CVP) readings are ordered every 4 hours; the client's CVP reading is 14 cm/Hâ‚‚O. Which evaluation by the nurse would be most accurate?

Correct Answer: D

Rationale: A CVP of 14 cm/Hâ‚‚O (normal: 3-8 cm/Hâ‚‚O) indicates fluid volume excess, likely from aggressive resuscitation, requiring careful monitoring to prevent complications.

Question 2 of 5

When performing Leopold maneuvers on a client at 32 weeks gestation, the nurse would expect to find:

Correct Answer: D

Rationale: At 32 weeks gestation, the fetus is active, and Leopold maneuvers should detect active fetal movement as the fetus is well-developed and mobile.

Question 3 of 5

An elderly client has a stage II pressure ulcer on her sacrum. During assessment of the client's skin, the nurse would expect to find:

Correct Answer: B

Rationale: A stage II pressure ulcer involves partial-thickness skin loss, appearing as a shallow crater with a nonpainful wound base.

Question 4 of 5

All of the following clients are at an increased risk for aspiration pneumonia EXCEPT

Correct Answer: B

Rationale: Aspiration pneumonia risk is high with nasogastric feeding, mechanical ventilation, and dysphagia due to potential airway entry of material.
Total parenteral nutrition (IV) bypasses the airway, reducing aspiration risk.

Question 5 of 5

The nurse is preparing to administer a dose of metoprolol (Lopressor) to a client with hypertension. The client’s heart rate is 58 beats per minute. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: metoprolol is a beta-blocker, and a heart rate of 58 beats per minute is below the threshold for administration, requiring physician notification

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