NCLEX Questions, ATI NCLEX-RN Practice Questions Questions, NCLEX-RN Questions, Nurselytic

Questions 158

NCLEX-RN

NCLEX-RN Test Bank

ATI NCLEX-RN Practice Questions Questions

Extract:


Question 1 of 5

Which action can be delegated to the licensed practical nurse?

Correct Answer: A, B, E

Rationale: LPNs can insert catheters (
A), perform tracheostomy care (
B), and change sterile dressings (E) within their scope. Initiating blood transfusions (
C) and irrigating PICC lines (
D) require RN-level assessment and monitoring.

Question 2 of 5

At 30 weeks' gestation, a client is admitted to the unit in premature labor. Her physician orders that an IV be started with 500 mL D5W mixed with 150 mg of ritodrine stat. The RN prepares the IV solution with the medication. The RN knows that clients receiving the medication ritodrine IV should be observed closely for which one of the following side effects:

Correct Answer: C

Rationale: Ritodrine is a sympathomimetic β2-adrenergic agonist that can cause vasodilation, leading to hypotension. The body compensates by increasing heart rate, resulting in tachycardia.

Question 3 of 5

A client had a ruptured abdominal aortic aneurysm that was repaired surgically. Her postoperative recovery progressed without complications, and she is ready for discharge. Client education in preparation for discharge began 7 days ago on her admission to the nursing unit. Evaluation of nursing care related to client education is based on evaluation of expected outcomes. Which statement made by the client would indicate that she is ready for discharge?

Correct Answer: C

Rationale: Postoperatively, clients with major abdominal surgery are instructed to avoid driving, riding in the front seat, and wearing seat belts because any sudden impact may injure a fresh incision. She should ride in back seat without a seat belt. Clients should not sit in the tub and allow the incision to soak in water because this may predispose the client to infection. A short, cool shower would be preferable. Allowing soap to come in contact with the incision would not harm it and is frequently used as postoperative wound care at home on discharge from the hospital. Activity instructions include: avoid sitting for long periods and get exercise by walking. Lifting more than 5 lb of weight is also prohibited. The client must also learn her diet. Her husband cooking is probably a temporary measure unless he did the cooking prior to her hospitalization. A statement such as this may indicate the need for further exploration of feelings regarding her illness, dependence, and self-care expectations.

Question 4 of 5

The physician has ordered an injection of RhoGAM (Rho[D] immune globulin) for the postpartum client whose blood type is A negative and whose baby is O positive. To provide postpartum prophylaxis,RhoGAM should be administered:

Correct Answer: A

Rationale: RhoGAM prevents Rh sensitization in Rh-negative mothers by neutralizing fetal Rh-positive blood cells. It must be administered within 72 hours of delivery for effective prophylaxis.

Question 5 of 5

The nurse is caring for a client with a history of Parkinson’s disease. The nurse should give priority to:

Correct Answer: A

Rationale: Parkinson’s disease causes bradykinesia and rigidity, increasing fall risk, so monitoring for falls is the priority.

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