NCLEX Questions, NCLEX Practice Test PN Questions, NCLEX-PN Questions, Nurselytic

Questions 164

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Question 1 of 5

The nurse is preparing to administer the fourth dose of IV vancomycin to a client. Which set of laboratory values would alert the nurse to hold the vancomycin and notify the health care provider?

Correct Answer: D

Rationale: A vancomycin trough of 23 mg/L is above the therapeutic range (10-20 mg/L), indicating potential toxicity. Elevated creatinine (1.5 mg/dL) suggests renal impairment, which increases the risk of vancomycin accumulation and nephrotoxicity.

Question 2 of 5

A client with acquired immunodeficiency syndrome has a T cell count of 180 . The medication frequently used for the client with T cell counts less than 200 is:

Correct Answer: C

Rationale: Pentamidine is used for Pneumocystis prophylaxis in AIDS patients with T-cell counts <200. Gentamicin is an antibiotic, acyclovir treats herpes, and immune globulin is not specific.

Question 3 of 5

What should be included in the care plan of a client who has myxedema?

Correct Answer: A

Rationale: Myxedema (severe hypothyroidism) causes fatigue; frequent rest periods conserve energy. Deep breathing, cool environments, or high-calorie snacks are not prioritized.

Question 4 of 5

The nurse is assisting with the care of a client who has diabetic ketoacidosis. The nurse should recognize that it is a priority to

Correct Answer: B

Rationale: In diabetic ketoacidosis, insulin administration is the priority to correct hyperglycemia and halt ketogenesis, addressing the underlying metabolic crisis.

Question 5 of 5

The nurse is caring for a client who experienced a sexual assault and has posttraumatic stress disorder. The client states, 'It is all my fault. I should not have accepted a drink from a stranger I met at a bar.' Which of the following responses would be most appropriate for the nurse to make?

Correct Answer: D

Rationale: This response validates the client's feelings while gently correcting self-blame, reinforcing that the assault was not their fault and promoting a supportive therapeutic environment.

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