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

Questions 149

NCLEX-RN

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Extract:


Question 1 of 5

The nurse is preparing to administer a dose of lisinopril (Zestril) to a client with hypertension. The client’s blood pressure is 100/60 mmHg. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: lisinopril is an ACE inhibitor

Question 2 of 5

The nurse is assessing the deep tendon reflexes of a client with preeclampsia. Which method is used to elicit the biceps reflex?

Correct Answer: A

Rationale: The biceps reflex is elicited by placing the thumb on the biceps tendon in the antecubital space and tapping it with a reflex hammer.

Question 3 of 5

The client who is 2 weeks post-burn with a 40% deep partial-thickness injury still has open wounds. The nurse's assessment reveals the following findings: temperature 96.5°F, BP 87/40, and severe diarrhea stools. What problem does the nurse most likely suspect?

Correct Answer: C

Rationale: Hypothermia, hypotension, and diarrhea suggest systemic gram-negative infection, likely sepsis, due to bacterial translocation from open wounds or the gut in a burn patient.

Question 4 of 5

The nurse has just received the shift report and is preparing to make rounds. Which client should be seen first?

Correct Answer: C

Rationale: The client with shortness of breath is at highest risk for respiratory distress and requires immediate assessment.

Question 5 of 5

A client seen in the doctor's office for complaints of nausea and vomiting is sent home with directions to follow a clear-liquid diet for the next 24-48 hours. Which of the following is not permitted on a clear-liquid diet?

Correct Answer: C

Rationale: Ice cream is not a clear liquid, as it is opaque and contains dairy.

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