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Questions 148

NCLEX-RN

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Extract:


Question 1 of 5

The nurse is caring for the client following a laryngectomy when suddenly the client becomes nonresponsive and pale, with a BP of 90/40. The initial nurse's action should be to:

Correct Answer: B

Rationale: Hypotension and unresponsiveness suggest hypovolemia or shock, so increasing the normal saline infusion is the initial action to restore volume.

Question 2 of 5

The nurse is assessing a client with suspected hypoparathyroidism. Which of the following findings would the nurse expect?

Correct Answer: A

Rationale: muscle cramps and tetany are signs of hypoparathyroidism due to hypocalcemia

Question 3 of 5

The nurse is caring for a cognitively impaired client who begins to pull at the tape securing his IV site. To prevent the client from removing the IV, the nurse should:

Correct Answer: A

Rationale: Securing the IV with tape out of the client's vision minimizes tampering while avoiding restraints or inappropriate actions.

Question 4 of 5

A 19-year-old male has been experiencing vomiting and diarrhea for 3 days due to food poisoning. The nurse expects a urine specific gravity of

Correct Answer: D

Rationale: Dehydration from vomiting and diarrhea increases urine specific gravity (normal 1.005-1.030). 1.041 indicates concentrated urine due to fluid loss.

Question 5 of 5

A Turkish-speaking client is scheduled for a colonoscopy, and the nurse must provide printed directions to the client, but directions are not available in Turkish. Which of the following is most appropriate?

Correct Answer: A

Rationale: Contacting a medical translator (
A) ensures accurate communication for critical medical instructions. Using a child (
B) is unreliable, pictures/pantomime (
C) may be unclear, and advising the daughter to find a translator (
D) shifts responsibility inappropriately.

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