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Questions 148

NCLEX-RN

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Extract:


Question 1 of 5

The nurse is preparing to administer a feeding via a nasogastric tube. The nurse would perform which of the following before initiating the feeding?

Correct Answer: A

Rationale: Aspirating stomach content confirms nasogastric tube placement, preventing aspiration.

Question 2 of 5

A client has a CVP monitor in place. Which would be included in the nursing care plan for this client?

Correct Answer: A

Rationale: CVP readings outside 3-8 cm of water may indicate fluid imbalance or catheter issues, requiring physician notification to prevent complications.

Question 3 of 5

The nurse is caring for a postcholecystectomy client who had the T-tube removed this AM. Two hours after removal of the T-tube, the nurse notes that the 4x4 dressing covering the stab site is saturated with dark, greenish-yellow drainage. It is MOST appropriate for the nurse to take which of the following actions?

Correct Answer: A

Rationale: expected that a stab wound will continue to drain until the wound seals; nurse should keep wound clean and dry

Question 4 of 5

The physician has ordered a blood test for H. pylori. The nurse should prepare the client by:

Correct Answer: B

Rationale: A blood test for H. pylori requires no special preparation, such as fasting or administration of substances.

Question 5 of 5

The client presents to the emergency room with a 'bull's eye' rash. Which question would be most appropriate for the nurse to ask the client?

Correct Answer: A

Rationale: A bull's eye rash is characteristic of Lyme disease, often caused by tick bites, making this the most relevant question.

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