NCLEX Questions, NCLEX PN Exam Practice Test Questions, NCLEX-PN Questions, Nurselytic

Questions 163

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Question 1 of 5

A woman in labor calls the nurse to assist her in the bathroom. The nurse notices a large amount of clear fluid on the bed linens. The nurse knows that fetal monitoring must now assess for what complication?

Correct Answer: C

Rationale: When the membranes rupture, there is increased risk initially of cord prolapse. Fetal heart rate patterns may show variable decelerations, which require immediate nursing action to promote gas exchange.

Question 2 of 5

A client in the medical-surgical unit has an indwelling urinary catheter. Which actions should the nurse implement to reduce the incidence of catheter-associated urinary tract infections? Select all that apply.

Correct Answer: B,C,E

Rationale: Using a separate container prevents cross-contamination. Keeping the bag below the bladder prevents urine backflow, reducing infection risk. E: Sterile technique minimizes pathogen introduction during specimen collection. A is incorrect as routine antiseptic cleansing can disrupt natural flora, increasing infection risk. D is incorrect as routine irrigation is not recommended unless medically indicated, as it can introduce pathogens.

Question 3 of 5

The nurse is auscultating an elderly bedridden client's breath sounds and hears crackles. What is the best interpretation of this finding?

Correct Answer: C

Rationale: Crackles in a bedridden elderly client suggest fluid in the lungs or atelectasis, which deep breathing can help clear. It's not normal, not immediately life-threatening, and oxygen is premature without further assessment.

Question 4 of 5

A newly admitted client describes symptoms of dizziness and feeling faint on standing. The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder. Which medications may be contributing to the client's symptoms? Select all that apply.

Correct Answer: C,D

Rationale: Metoprolol, a beta-blocker, can cause orthostatic hypotension, leading to dizziness on standing. Olanzapine, an antipsychotic, is associated with orthostatic hypotension as a side effect. A, B, and E are not commonly linked to orthostatic symptoms; atorvastatin manages cholesterol, metformin controls blood sugar, and omeprazole reduces stomach acid.

Question 5 of 5

The nurse is providing diet instruction to the parents of a child with cystic fibrosis. The nurse would emphasize that the diet should be

Correct Answer: C

Rationale: High protein, high calorie, unrestricted fat. The child with Cystic Fibrosis needs a well balanced diet that is high in protein and calories. Fat does not need to be restricted.

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