NCLEX Questions, ATI NCLEX-RN Practice Questions Questions, NCLEX-RN Questions, Nurselytic

Questions 158

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Extract:


Question 1 of 5

The nurse is caring for a client with myasthenia gravis who is having trouble breathing. The nurse would encourage which of the following positions for maximal lung expansion?

Correct Answer: D

Rationale: Sitting or high Fowler’s position maximizes lung expansion by reducing diaphragm pressure in myasthenia gravis. Supine (
A), side-lying (
B), and prone (
C) positions restrict breathing.

Question 2 of 5

A client hospitalized for treatment of congestive heart failure is to be discharged with a prescription for Digitek (digoxin) 0.25 mg daily. Which of the following statements indicates that the client needs further teaching?

Correct Answer: B

Rationale: Taking digoxin with an antacid can decrease its absorption, reducing effectiveness, so this statement indicates a need for further teaching.

Question 3 of 5

A two-year-old is being evaluated for hearing loss. Which finding in the child's history is likely to be a significant factor?

Correct Answer: D

Rationale: Meningitis treated with garamycin (gentamicin) is a significant risk factor for hearing loss as gentamicin is ototoxic and meningitis can damage auditory nerves. The other factors are less directly associated with hearing impairment.

Question 4 of 5

An elderly client is hospitalized for a transurethral prostatectomy. Which finding should be reported to the doctor immediately?

Correct Answer: B

Rationale: Bright red urine with many clots post-TURP indicates significant bleeding or clot obstruction, requiring immediate reporting to prevent complications. The other findings are less urgent.

Question 5 of 5

The nurse is caring for a 2-year-old girl with a subdural hematoma of the temporal area as a result of falling out of bed and notices that she has a runny nose. The nurse should:

Correct Answer: C

Rationale: The nasal discharge could be due to a cold. It is necessary to gather additional assessment data to identify a possible cerebrospinal fluid leak. If the discharge is cerebrospinal fluid, it would not be safe to encourage the girl to blow her nose. Cerebrospinal fluid is positive for sugar; mucus is not. Turning her to her side will have no effect on her 'runny nose.' It is necessary to gather further assessment data.

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