NCLEX Questions, NCLEX-RN Exam Questions, NCLEX-RN Questions, Nurselytic

Questions 158

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Question 1 of 5

The nurse is preparing to administer a dose of insulin lispro (Humalog). When is the onset of action for this medication?

Correct Answer: A

Rationale: Insulin lispro, a rapid-acting insulin, has an onset of 5–15 minutes, making it ideal for pre-meal administration. Other insulins have slower onsets.

Question 2 of 5

The nurse working with a client who is out of control should follow a model of intervention that includes which of the following?

Correct Answer: A

Rationale: Approaching a client's aggressive behavior on a continuum of least restrictive care is in agreement with his or her rights (i.e., verbal methods to help maintain control, medication, seclusion, and restraints, as necessary). Approaching a client in a challenging manner is threatening and inappropriate. A non-challenging and calm approach reflects staff in control and may increase client's internal control. It is inappropriate to leave an aggressive client who is acting out alone. The nurse should acquire qualified help to prevent client from harm or injury to self or others. Moving a client to seclusion immediately for shouting is inappropriate. The nurse should offer the client an opportunity to control self with limit setting. The client should understand that the staff will assist with control if necessary (i.e., quietly accompany out of environment to decrease stimulation and allow for verbalization) employing the least restrictive care model of intervention.

Question 3 of 5

A 16-year-old client reports a weight loss of 20% of her previous weight. She has a history of food binges followed by self-induced vomiting (purging). The nurse should suspect a diagnosis of:

Correct Answer: C

Rationale: Bulimia is characterized by binge eating followed by purging, such as self-induced vomiting, leading to significant weight loss.

Question 4 of 5

A female client at 36 weeks' gestation is experiencing preterm labor. Her physician has prescribed two doses of betamethasone 12 mg IM q24h. The nurse explains that she is receiving this drug to:

Correct Answer: C

Rationale: Respiratory distress syndrome occurs in the newborn, not the fetus. It may be treated postnatally with surfactant therapy. Betamethasone is a corticosteroid, not an anti-infective drug; therefore, its use would not prevent uterine infection. Betamethasone binds with glucocorticoid receptors in alveolar cells to increase production of surfactant, thus increasing lung maturity in the preterm fetus. Betamethasone does not affect uteroplacental circulatory exchange.

Question 5 of 5

A client with hyperthyroidism is taking Eskalith (lithium carbonate) to inhibit thyroid hormone release. Which complaint by the client should alert the nurse to a problem with the client's medication?

Correct Answer: B

Rationale: Increased thirst and urination suggest lithium toxicity, as lithium can cause polyuria and polydipsia. Blurred vision and weight gain are less specific, and rhinorrhea is unrelated.

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