NCLEX-RN
NCLEX RN Test Bank Questions PDF Questions
Extract:
Question 1 of 5
The nurse caring for a child diagnosed with leukemia notes that the platelet count is 20,000 mm3 (20 x 10^9/L). Based on this finding, the nurse should include which interventions in the plan of care? Select all that apply.
Correct Answer: A,B,C
Rationale: A platelet count of 20,000 mm3 (20 x 10^9/L) places the child at risk for bleeding. The remaining options 1, 2, and 3 are accurate interventions. Taking rectal temperatures and the use of suppositories are avoided because of the risk of rectal bleeding.
Question 2 of 5
Which type of anemia is diagnosed with a Schilling test?
Correct Answer: B
Rationale: The Schilling test is used to determine the cause of vitamin B12 deficiency, a potential precursor to pernicious anemia. This test involves the use of a small oral dose of radioactive B12 and a large nonradioactive intramuscular dose. A 24-hour urine specimen is then collected to measure the amount of radioactivity in the urine, and thus radioactive B12. This test is not helpful in diagnosing aplastic, megaloblastic, or iron-deficiency anemia.
Question 3 of 5
The nurse is caring for a client with a history of hyperthyroidism who is prescribed methimazole (Tapazole). The nurse should monitor the client for which of the following adverse effects?
Correct Answer: A
Rationale: Methimazole can cause agranulocytosis, a serious reduction in white blood cells, requiring monitoring.
Question 4 of 5
An adolescent tells the school nurse she thinks she has infectious mononucleosis. The nurse should next assess the client for?
Correct Answer: A
Rationale: Sore throat and malaise are hallmark symptoms of mononucleosis, requiring targeted assessment.
Question 5 of 5
The nurse is caring for a client who has been diagnosed with deep vein thrombosis. When assessing the client's vital signs, the nurse notes an apical pulse of 150 bpm, a respiratory rate of 46 breaths/minutes, and blood pressure of 100/60 mm Hg. The client appears anxious and restless. What should be the nurse's first course of action?
Correct Answer: A
Rationale: These symptoms suggest a possible pulmonary embolism, a life-threatening complication of DVT, requiring immediate physician notification.