NCLEX Questions, NCLEX PN Test Questions Questions, NCLEX-PN Questions, Nurselytic

Questions 164

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Question 1 of 5

The nurse is assessing a young child at a clinic visit for a mild respiratory infection. Koplik spots are noted on the oral mucous membranes. The nurse should then assess which area of the body?

Correct Answer: A

Rationale: The skin. A characteristic sign of rubeola is Koplik spots (small red spots with a bluish white center). These are found on the buccal mucosa about 2 days before and after the onset of the measles rash.

Question 2 of 5

The nurse is preparing to administer IV furosemide to a client with chronic kidney disease. The nurse should administer the medication slowly to prevent

Correct Answer: B

Rationale: Rapid IV furosemide can cause ototoxicity (
B) in CKD patients due to drug accumulation. Oliguria (
A) is already present, and furosemide does not typically cause bradycardia (
C) or hypertension (
D).

Question 3 of 5

An 8-year old is admitted with drooling, muffled phonation and a temperature of 102.6°. The nurse should immediately notify the doctor because the child's symptoms are suggestive of:

Correct Answer: B

Rationale: Drooling, muffled phonation, and fever suggest epiglottitis, a medical emergency requiring immediate intervention due to the risk of airway obstruction.

Question 4 of 5

The nurse is caring for assigned clients. The nurse should first check the client with

Correct Answer: D

Rationale: Pericarditis with paradoxical pulse (
D) suggests tamponade, requiring immediate assessment. Atrial fibrillation (
C), pneumonia (
B), and cirrhosis (
A) are less urgent.

Question 5 of 5

A 31-year-old client is admitted to the psychiatric unit after cutting both wrists with a kitchen knife. The client has a diagnosis of borderline personality disorder. The most therapeutic approach by the nurse is one that is:

Correct Answer: C

Rationale: A firm and consistent approach provides structure and boundaries, which are therapeutic for clients with borderline personality disorder who often test limits.

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