NCLEX Questions, NCLEX RN Practice Test Questions, NCLEX-RN Questions, Nurselytic

Questions 149

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Extract:


Question 1 of 5

The home health nurse is scheduled to visit four clients. Which client should she visit first?

Correct Answer: A

Rationale: The AIDS client with fever and cough may have an acute infection like pneumonia, requiring urgent assessment.

Question 2 of 5

The nurse is caring for a client with COPD. Which of the associated disorders has changes that are reversible?

Correct Answer: C

Rationale: Asthma is characterized by reversible airway obstruction, unlike bronchiectasis, emphysema, and chronic bronchitis, which involve permanent structural changes.

Question 3 of 5

The nurse is assessing the heart sounds of a client with mitral stenosis following a history of rheumatic fever. To hear a mitral murmur, the nurse should place the stethoscope at:

Correct Answer: D

Rationale: Mitral stenosis murmurs are best heard at the fourth intercostal space midclavicular line, the mitral valve area.

Question 4 of 5

A client in Dunlop traction experiences numbness of the thumb and index finger and cannot move the thumb to touch the tips of the other fingers. The capillary refill time is four seconds. Which of the following actions is indicated?

Correct Answer: A

Rationale: Numbness, impaired thumb movement, and delayed capillary refill suggest compression from a tight elastic bandage. Removing and reapplying it loosely (
A) addresses this. Adjusting weights (B,
D) or countertraction (
C) does not address the symptoms.

Question 5 of 5

The nurse is caring for a client with marked clubbing of the fingers and toes. The nurse understands which to be true regarding clubbing? Select all that apply.

Correct Answer: A,C,E,F

Rationale: Clubbing is permanent, associated with sickle cell disease, right-sided heart failure, and congenital heart defects due to chronic hypoxia. Dialysis and acute oxygen deprivation are not typical causes.

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