NCLEX Questions, NCLEX-RN Exam Practice Questions, NCLEX-RN Questions, Nurselytic

Questions 157

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Extract:


Question 1 of 5

When assessing the client's blood pressure, the nurse should use a cuff with a width that is __% of the circumference of the extremity. (Fill in the blank.)

Correct Answer: 40

Rationale: The blood pressure cuff width should be approximately 40% of the extremity’s circumference to ensure accurate readings. A cuff too narrow or wide can falsely elevate or lower readings.

Question 2 of 5

The client is receiving a continuous infusion of insulin for diabetic ketoacidosis. Which laboratory value should the nurse monitor most closely?

Correct Answer: A

Rationale: Insulin therapy in diabetic ketoacidosis shifts potassium into cells, risking hypokalemia, which can cause arrhythmias. Sodium, BUN, and A1C are monitored but are less critical during acute treatment.

Question 3 of 5

A client has been diagnosed with congestive heart failure. His fluid intake and output are strictly regulated. For lunch, he drank 8 oz of milk, 4 oz of tea, and 6 oz of coffee. His intake would be recorded as:

Correct Answer: B

Rationale: 1 oz = 30 mL; therefore, 18 oz = 540 mL.

Question 4 of 5

The nurse is discharging a client with a prescription of eyedrops.

Correct Answer: B

Rationale: Administering a second eyedrop immediately (
B) prevents absorption of the first, indicating a need for teaching (wait 5–10 minutes). Shaking (
A), hand washing (
C), and proper instillation (
D) are correct.

Question 5 of 5

A client with a history of a kidney transplant is receiving Prednisone. The nurse should monitor the client for:

Correct Answer: A

Rationale: Prednisone, a corticosteroid, suppresses immunity, increasing infection risk. Hypotension, hyperkalemia, and weight loss are not primary concerns; weight gain is more common.

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