Questions 151

NCLEX-RN

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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

A client with a history of chronic lymphocytic leukemia is admitted with fatigue. The nurse should monitor the client for which of the following?

Correct Answer: A

Rationale: Chronic lymphocytic leukemia can cause anemia due to bone marrow suppression, leading to fatigue.

Question 3 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 4 of 5

The nurse is caring for a client post-cataract surgery. Which instruction should the nurse include in discharge teaching?

Correct Answer: A

Rationale: Avoiding bending at the waist prevents increased intraocular pressure, which could complicate recovery post-cataract surgery.

Question 5 of 5

A client with a history of bipolar disorder is prescribed lithium. The nurse should instruct the client to:

Correct Answer: A

Rationale: Consistent sodium intake prevents lithium toxicity, as sodium fluctuations affect lithium levels.

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