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

Questions 164

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Question 1 of 5

The nurse is caring for a client at 12 weeks gestation who has a rubella titer status of nonimmune. Which of the following actions should the nurse anticipate implementing?

Correct Answer: B

Rationale: MMR is contraindicated during pregnancy due to risks to the fetus. Administering it postpartum ensures immunity for future pregnancies without harming the current pregnancy.

Question 2 of 5

The nurse is caring for a client with a vascular access for hemodialysis. Which of these findings necessitates immediate action by the nurse?

Correct Answer: D

Rationale: It is a priority to report this finding since clients on hemodialysis are prone to infection, and the first sign is an elevated temperature.

Question 3 of 5

A 9-year-old with type 1 diabetes takes insulin glargine and NPH regularly. While at school, the client becomes shaky, diaphoretic, and pale. What is the most appropriate action by the nurse?

Correct Answer: D

Rationale: Shakiness, diaphoresis, and pallor indicate hypoglycemia. Providing 15 grams of fast-acting carbohydrates, such as 4 oz of a regular soft drink, is the first-line treatment.

Question 4 of 5

A client is prescribed long-term pharmacologic therapy with hydroxychloroquine to treat systemic lupus erythematosus. The nurse should reinforce teaching about which intervention related to the drug's adverse effects?

Correct Answer: A

Rationale: Hydroxychloroquine can cause retinal toxicity. Regular ophthalmologic exams every 6 months are essential to monitor for early signs of retinal damage.

Question 5 of 5

The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What actions should the nurse perform initially? Select all that apply.

Correct Answer: A,B,D

Rationale: Checking for distention/constipation (
A), examining for catheter issues (
B), and repositioning to a side-lying position (
D) address common causes of outflow issues non-invasively.

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