NCLEX Questions, NCLEX-RN Exam Questions, NCLEX-RN Questions, Nurselytic

Questions 158

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Extract:


Question 1 of 5

The nurse is caring for a client post-appendectomy. Which finding requires immediate intervention?

Correct Answer: B

Rationale: A temperature of 101.5°F post-appendectomy suggests infection (e.g., abscess), requiring immediate intervention. Pain (
A), serous drainage (
C), and absent bowel sounds (
D) are expected initially.

Question 2 of 5

A female client at 36 weeks' gestation is experiencing preterm labor. Her physician has prescribed two doses of betamethasone 12 mg IM q24h. The nurse explains that she is receiving this drug to:

Correct Answer: C

Rationale: Respiratory distress syndrome occurs in the newborn, not the fetus. It may be treated postnatally with surfactant therapy. Betamethasone is a corticosteroid, not an anti-infective drug; therefore, its use would not prevent uterine infection. Betamethasone binds with glucocorticoid receptors in alveolar cells to increase production of surfactant, thus increasing lung maturity in the preterm fetus. Betamethasone does not affect uteroplacental circulatory exchange.

Question 3 of 5

The healthcare team determines that an elderly client has had progressive changes in memory over the last 2 years that have interfered with her personal, social, or occupational functioning. Her memory, learning, attention, and judgment have all been affected in some way. These symptoms describe which of the following conditions?

Correct Answer: A

Rationale: These changes are common characteristics of dementia.

Question 4 of 5

The physician prescribes regular insulin, five units subcutaneous. Regular insulin begins to exert an effect:

Correct Answer: C

Rationale: Regular insulin (short-acting) has an onset of 30–60 minutes when given subcutaneously, peaking at 2–3 hours. This allows time for absorption and glucose-lowering effects.

Question 5 of 5

The nurse is caring for a postoperative client when the client becomes nonresponsive and pale,with a BP of 90/40. The nurse recognizes that the necessary intervention at this time is to:

Correct Answer: B

Rationale: Hypotension (BP 90/40) pallor,and nonresponsiveness suggest hypovolemic shock likely from postoperative bleeding. Increasing the IV infusion rate (e.g. saline) restores volume. Trendelenburg is controversial atropine treats bradycardia,and the emergency cart is secondary to immediate fluid resuscitation.

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