NCLEX Questions, NCLEX Trainer Test 3 Questions, NCLEX-PN Questions, Nurselytic

Questions 157

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Question 1 of 5

A postoperative client has a nasogastric (NG) tube following bowel surgery. The orders read, 'acetaminophen 650 PRN for fever above 101°F.' The client has a temperature of 101.4°F. What is the most appropriate nursing action?

Correct Answer: A

Rationale: A rectal suppository is appropriate with an NG tube on suction, ensuring fever treatment without risking medication loss.

Question 2 of 5

The physician has ordered insertion of a nasogastric tube to provide supplemental feedings for a client recovering from a stroke. To facilitate insertion of the nasogastric tube, the nurse should:

Correct Answer: B

Rationale: Flexing the neck aligns the esophagus, facilitating nasogastric tube insertion. Ice chips increase choking risk. Hyperextension misaligns the airway. Warm water is ineffective.

Question 3 of 5

Which of the following statements describes Piaget's stage of concrete operations?

Correct Answer: C

Rationale: Concrete operations (ages 7-11) involve logical, coherent thought about concrete events. Perspective-taking develops but is not primary, and abstract thinking is characteristic of later stages.

Question 4 of 5

An adult is receiving lithium carbonate 600 mg tid. Which of the following observations is of greatest concern to the nurse?

Correct Answer: B

Rationale: A low-sodium diet increases lithium retention, risking toxicity, a serious concern requiring immediate education or intervention.

Question 5 of 5

The nurse is assessing a client with suspected appendicitis.

Correct Answer: B

Rationale: Positive rebound tenderness at McBurney’s point is a hallmark of appendicitis, indicating peritoneal irritation. Supine positioning may worsen pain, absent bowel sounds suggest obstruction, and a normal WBC count does not rule out appendicitis.

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