NCLEX Questions, NCLEX Trainer Test 4 Questions, NCLEX-PN Questions, Nurselytic

Questions 157

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Extract:


Question 1 of 5

The nurse is caring for a client in the coronary care unit. The display on the cardiac monitor indicates ventricular fibrillation. What should the nurse do first?

Correct Answer: C

Rationale: Assess for presence of pulse. Verifying the absence of a pulse confirms ventricular fibrillation before proceeding with treatment.

Extract:

A client is being treated for hypovolemia.


Question 2 of 5

Which of the following observations should the nurse identify as the desired response to fluid replacement?

Correct Answer: D

Rationale: Strategy: Determine the significance of each answer choice and how it relates to hypovolemia. (1) indicates a hypovolemic state (2) indicates a hypovolemic state (3) indicates acidosis (4) correct-normal range for CVP is 3-8 cm water pressure (or 2-6 mm Hg); reading of 8 cm water pressure would indicate a desired response to fluid replacement

Extract:


Question 3 of 5

In evaluating the growth of a 12 month-old child, which of these findings would the nurse expect to be present in the infant?

Correct Answer: C

Rationale: Tripled the birth weight. Infants typically triple their birth weight by 12 months.

Question 4 of 5

A 13 year old girl is admitted to the ER with lower right abdominal discomfort. The admitting nursing should take which the following measures first?

Correct Answer: D

Rationale: Do not administer pain medication or start a central line without MD orders.

Question 5 of 5

When providing nursing measures to relieve a 102-degree Fahrenheit fever in a toddler with an infection, what is the most effective intervention?

Correct Answer: A

Rationale: Use medications to lower the temperature set point. Antipyretics effectively reduce fever by adjusting the hypothalamic set point, preventing complications like seizures.

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