Questions 150

NCLEX-RN

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Question 1 of 5

The nurse is caring for a client with a history of venous insufficiency who is prescribed horse chestnut extract. The nurse should instruct the client to report which of the following side effects immediately?

Correct Answer: B

Rationale: Horse chestnut extract may increase bleeding risk, so bleeding should be reported immediately.

Question 2 of 5

A client with a history of type 1 diabetes is admitted with diabetic ketoacidosis. The nurse should monitor the client for which of the following electrolyte imbalances? Select all that apply.

Correct Answer: A, C

Rationale: Diabetic ketoacidosis can cause hypokalemia (insulin shifts potassium) and hypophosphatemia (osmotic diuresis).

Question 3 of 5

The nurse is evaluating the effectiveness of antimicrobial therapy for a client diagnosed with infective endocarditis. The nurse determines that which finding is the least reliable indicator of effectiveness?

Correct Answer: B

Rationale: A systolic heart murmur, once present in the client, will not resolve spontaneously and is therefore the least reliable indicator. Clear breath sounds are a normal finding, and in this instance could mean resolution of heart failure, if that was accompanying the endocarditis. Negative blood cultures and normothermia indicate resolution of infection.

Question 4 of 5

You assess your family as having a deficit in terms of their instrumental activities of daily living (ADLs). Which healthcare professional would you most likely refer this family to in order to address this deficit?

Correct Answer: C

Rationale: Occupational therapists specialize in helping individuals improve their ability to perform instrumental activities of daily living (e.g., managing finances, cooking), making them the most appropriate referral for this deficit.

Question 5 of 5

Before the nurse administers I.V. replacement of 5% dextrose in water with potassium chloride, what nursing intervention must be completed first?

Correct Answer: B

Rationale: Evaluating electrolyte levels, especially potassium, is critical before administering potassium chloride to prevent hyperkalemia. Adding potassium at the bedside is unsafe, and priming or checking rates follows.

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