NCLEX Questions, NCLEX Practice Test RN Questions, NCLEX-RN Questions, Nurselytic

Questions 158

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Question 1 of 5

The nurse is caring for a client with a history of Addison’s disease. The nurse should expect the client to have:

Correct Answer: A

Rationale: Addison’s disease causes adrenal insufficiency, reducing cortisol and aldosterone, leading to hypotension due to fluid and sodium loss.

Question 2 of 5

The nurse is checking the client's central venous pressure. The nurse should place the zero of the manometer at the:

Correct Answer: A

Rationale: The phlebostatic axis (located at the fourth intercostal space mid-axillary line) is the standard reference point for zeroing the manometer to accurately measure central venous pressure. The other options are incorrect anatomical landmarks.

Question 3 of 5

The nurse is providing dietary instructions for a client with iron-deficiency anemia. Which food is a poor source of iron?

Correct Answer: A

Rationale:
Tomatoes are a poor source of iron compared to legumes, dried fruits, and nuts, which are rich in iron.
Tomatoes provide vitamin C, which aids iron absorption, but lack significant iron content.

Question 4 of 5

Before administering a client's morning dose of Lanoxin (digoxin), the nurse checks the apical pulse rate and finds a rate of 54. The appropriate nursing intervention is to:

Correct Answer: C

Rationale: A pulse rate below 60 bpm indicates bradycardia, a contraindication for digoxin due to the risk of worsening heart block. The nurse should withhold the dose and notify the physician.

Question 5 of 5

When a client is receiving vasoactive therapy IV, such as dopamine (Intropin), and extravasation occurs, the nurse should be prepared to administer which of the following medications directly into the site?

Correct Answer: A

Rationale: Phentolamine is given to counteract the-adrenergic effects that cause ischemia and necrosis of local tissue. Epinephrine is an endogenous catecholamine that produces vasoconstriction and increases heart rate and contractility. Phenylephrine causes constriction of arterioles of skin, mucous membranes, and viscera, which in turn can cause ischemia and necrosis. Sodium bicarbonate is an alkalinizing agent that is incompatible with dopamine.

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