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Questions 148

NCLEX-RN

NCLEX-RN Test Bank

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Extract:


Question 1 of 5

The nurse is teaching a client with a new colostomy about dietary management. Which of the following foods should the nurse recommend the client avoid to reduce odor and gas?

Correct Answer: A

Rationale: broccoli is a gas-forming food that can increase odor and gas in a colostomy

Question 2 of 5

The nurse enters a client's room and finds him lying on the floor. The client says to the nurse, 'I fell because I was trying to go to the bathroom and no one answered my call light.' Which of the following actions by the nurse are correct? Select all that apply.

Correct Answer: A,B,C,D,E

Rationale: All actions are appropriate: assist the client safely, assess for injuries, notify the provider, complete an incident report, and document the fall to ensure proper care and follow-up.

Question 3 of 5

The nurse is caring for the client following a laryngectomy when suddenly the client becomes nonresponsive and pale, with a BP of 90/40. The initial nurse's action should be to:

Correct Answer: B

Rationale: Hypotension and unresponsiveness suggest hypovolemia or shock, so increasing the normal saline infusion is the initial action to restore volume.

Question 4 of 5

The nurse is caring for a cognitively impaired client who begins to pull at the tape securing his IV site. To prevent the client from removing the IV, the nurse should:

Correct Answer: A

Rationale: Securing the IV with tape out of the client's vision minimizes tampering while avoiding restraints or inappropriate actions.

Question 5 of 5

A student nurse is assigned to change a patient's dressing. The soiled bandage is saturated with bright red blood. How should the student nurse dispose of the bandage?

Correct Answer: B

Rationale: Blood-saturated bandages are biohazardous and must be disposed of in a labeled biohazard bag to prevent infection transmission.

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