NCLEX Questions, NCLEX Trainer Test 10 Questions, NCLEX-PN Questions, Nurselytic

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Question 1 of 5

The nurse is preparing to administer digoxin (Lanoxin) to a client. The client's apical pulse is 56 beats per minute. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: digoxin is held if the apical pulse is below 60 beats per minute in adults to prevent toxicity

Question 2 of 5

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

Correct Answer: B

Rationale: rebound tenderness at McBurney's point is a classic sign of appendicitis

Question 3 of 5

A client is started on doxepin hydrochloride (Sinequan) 75 mg PO tid. The nurse should recommend a change in the client's therapy if which of the following occurs?

Correct Answer: B

Rationale: doxepin HCL (Sinequan) is an antidepressant; signs of overdosage include excitability and tremors

Question 4 of 5

At approximately 6 PM, the nurse begins to open the nurses' notes for the evening shift. The last entry is noted for 1 PM, and there is no signature. The MOST appropriate nursing response is to

Correct Answer: C

Rationale: day nurse can make a 'late entry' to add any additional information

Question 5 of 5

The nurse is caring for a client who is receiving IV fluids at 150 mL/hour. Which of the following findings would be of GREATest concern to the nurse?

Correct Answer: C

Rationale: Crackles in the lung bases suggest fluid overload, a serious complication of IV fluids, potentially leading to pulmonary edema. Options A, B, and D are normal or less concerning: blood pressure 140/90 mmHg and heart rate 90 bpm are stable, and urine output 100 mL/hour is adequate.

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