Questions 151

NCLEX-RN

NCLEX-RN Test Bank

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Extract:


Question 1 of 5

Which laboratory value would you report to the doctor because it is not normal and it is also a significant change in the client?

Correct Answer: D

Rationale:
Total bilirubin of 17 umol/L (1 mg/dL) is elevated (normal 0.1-1.0 mg/dL), indicating potential liver or biliary issues, requiring reporting.

Question 2 of 5

Select the basic sterile asepsis procedures that are accurate. Select all that apply:

Correct Answer: A,C,E

Rationale: Sterile items only on the sterile field , coughing/sneezing contaminating the field , and moisture contaminating the field are accurate sterile asepsis principles. The sterile field must be above waist level (B is incorrect), a 1-inch border is standard (D is incorrect), and masks are not required for clients (F is incorrect).

Question 3 of 5

A client who has glaucoma has been prescribed timolol (Timoptic) eyedrops. Which of the following instructions should the nurse give the client about the administration of the eyedrops?

Correct Answer: B

Rationale: Timolol eyedrops may cause transient eye discomfort, such as stinging or burning, which is a common side effect. Instilling drops only when eyes are irritated is incorrect, as timolol requires regular dosing. Refrigeration is not necessary, and reevaluation timing depends on the physician's plan, not a fixed month.

Question 4 of 5

Which of the following would be most important for the nurse to include in the teaching plan for a client who is taking phenelzine (Nardil)?

Correct Answer: D

Rationale: Phenelzine, an MAOI, requires avoiding tyramine-rich foods to prevent hypertensive crisis.

Question 5 of 5

A client with a history of cardiac problems is having severe chest pain. What should be nurse's first response?

Correct Answer: C

Rationale: Assessing the client's chest pain is the first step to determine its nature and severity, guiding further actions like notifying the physician or administering oxygen or analgesics.

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