NCLEX-PN
NCLEX Trainer Test 2 Questions
Extract:
A 30-year-old woman is admitted to the hospital with dry mucous membranes and decreased skin turgor. The woman's vital signs are BP 120/70, temperature 101°F (38.3°C), pulse 88, respirations 14. Laboratory Test s indicate the serum sodium is 150 mEq/L and the Hct is 48%.
Question 1 of 5
The nurse would expect the physician to order which of the following IV fluids?
Correct Answer: B
Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) hypertonic solutions contraindicated in dehydration (2) correct-hypotonic solution, shifts fluid into intracellular space to correct dehydration (3) isotonic solution, not best with dehydration (4) isotonic solution used to replace electrolytes
Extract:
Question 2 of 5
Which diet selection contains the most potassium and should be removed from the tray of the client with renal failure?
Correct Answer: B
Rationale: Baked potatoes are high in potassium, which is restricted in renal failure to prevent hyperkalemia. Peach , marshmallows , and bread have lower potassium content.
Question 3 of 5
The nurse recognizes which of these symptoms as characteristic of a panic attack?
Correct Answer: A
Rationale: panic disorders are characterized by recurrent, unpredictable attacks of intense apprehension or terror that can render a client unable to control a situation or to perform simple tasks; client can experience palpitations, chest pain, shortness of breath, a decrease in perceptual field, and a fear of 'losing it' or going crazy
Question 4 of 5
The nurse is screening an eight-month-old girl in a well-baby clinic. The nurse would be MOST concerned if the infant's mother made which of the following statements?
Correct Answer: A
Rationale: An eight-month-old should have doubled birth weight by 5–6 months; 'almost doubled' suggests growth delay, requiring evaluation. Options B, C, and D are normal behaviors.
Extract:
A client two days after surgery, a shiny, pink, open area is noted with the underlying bowel visible.
Question 5 of 5
When the nurse assesses the incision of a client two days after surgery, a shiny, pink, open area is noted with the underlying bowel visible. Which of these actions should the nurse take FIRST?
Correct Answer: A
Rationale: Strategy: All answers are implementation. Determine the outcome of each answer. Is it desired? (1) correct-evisceration is treated immediately by application of sterile gauze soaked in sterile normal saline, followed by notification of physician (2) not correct response to this complication (3) not correct response to this complication (4) not correct response to this complication