NCLEX Questions, Mock 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 with a diagnosis of gestational hypertension. Which symptom is most characteristic?

Correct Answer: A

Rationale: Hypertension (BP ≥140/90) is the defining symptom of gestational hypertension. Proteinuria indicates preeclampsia and fetal macrosomia or painful bleeding are unrelated.

Question 2 of 5

The nurse is caring for a client with a cerebrovascular accident (CVA) who is complaining of being nauseated and is requesting an emesis basin. Which action would the nurse take first?

Correct Answer: C

Rationale: Turning the client to one side prevents aspiration, a priority in a nauseated CVA client with potential swallowing deficits. Administering an antiemetic (
A) or notifying the physician (
D) is secondary, and ice (
B) is ineffective.

Question 3 of 5

The charge nurse is formulating a discharge teaching plan for a client with mild preeclampsia. The nurse should give priority to:

Correct Answer: A

Rationale: Nosebleeds in preeclampsia may indicate severe hypertension or coagulopathy, requiring immediate reporting. Pedal edema is common, bed rest is not always needed, and sodium restriction is secondary.

Question 4 of 5

A 74-year-old female client is 3 days postoperative. She has an indwelling catheter and has been progressing well. While the nurse is in the room, the client states, 'Oh dear, I feel like I have to urinate again!' Which of the following is the most appropriate initial nursing response?

Correct Answer: B

Rationale: The most frequent reason for an urge to void with an indwelling catheter is blocked tubing, so checking the catheter's patency is the best initial response.

Question 5 of 5

The physician has ordered Eskalith (lithium carbonate) 500 mg three times a day and Risperdal (risperidone) 2 mg twice daily for a client admitted with bipolar disorder, acute manic episodes. The best explanation for the client's medication regimen is:

Correct Answer: B

Rationale: Risperidone, an antipsychotic, is used to control acute manic symptoms like agitation, while lithium stabilizes mood over time, addressing the immediate behavioral excitement.

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