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

Questions 149

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Question 1 of 5

The nurse is teaching a client with a new diagnosis of migraine headaches about trigger avoidance. Which of the following should the client avoid?

Correct Answer: B

Rationale: aged cheeses contain tyramine, a common migraine trigger

Question 2 of 5

The nurse is assessing the laboratory results of a client scheduled to receive phenytoin (Dilantin). The Dilantin level, drawn 2 hours ago, is 30 mcg/mL. What is the appropriate nursing action?

Correct Answer: B

Rationale: A Dilantin level of 30 mcg/mL is above the therapeutic range (10-20 mcg/mL), indicating toxicity risk. The nurse should hold the dose and notify the physician for further orders.

Question 3 of 5

Which type of leukemia is more common in older adults?

Correct Answer: C

Rationale: Chronic lymphocytic leukemia (CLL) is most common in older adults, typically diagnosed in those over 60, due to its indolent nature and prevalence in this age group.

Question 4 of 5

A neonatal nurse assesses a premature newborn baby using the Apgar score. All of the following assessments are given a score EXCEPT

Correct Answer: D

Rationale: The Apgar score evaluates appearance, pulse, grimace, activity, and respiration. Rooting (a feeding reflex) is not part of the Apgar assessment.

Question 5 of 5

The nurse is precepting a student nurse who is helping to care for a client with a hip fracture. The client has Buck's traction applied. Which statement by the student nurse indicates a need for further explanation by the primary nurse?

Correct Answer: B

Rationale: Buck’s traction is skin traction, not skeletal traction, which uses pins. The other statements are correct regarding weight, positioning, and pin care (though pin care applies to skeletal traction).

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