NCLEX-RN
NCLEX RN Medical Surgical Questions Questions
Extract:
Question 1 of 5
A client 2 days ago. What should the nurse include in the client's plan of care? Select all that apply.
Correct Answer: B,C,D,E
Rationale: Positioning pillows for abduction, appropriate positioning, avoiding bending, and applying ice promote healing and prevent dislocation. Pointing toes inward is incorrect.
Question 2 of 5
A client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside equipment to:
Correct Answer: D
Rationale: Tracheotomy equipment is essential due to the risk of airway obstruction from swelling or hemorrhage post-thyroidectomy.
Question 3 of 5
The nurse develops a teaching plan for a client scheduled for a spinal fusion. Which of the following should the nurse expect to include?
Correct Answer: A
Rationale: The donor site (e.g., iliac crest) often causes more pain than the fusion site due to tissue trauma.
Question 4 of 5
The nurse is assessing a client with hepatitis and notices that the AST and ALT levels have increased. Which of the following statements by the client requires further instruction by the nurse?
Correct Answer: D
Rationale: Acetaminophen (
D) is hepatotoxic and should be avoided in hepatitis due to increased liver enzyme levels. Rest (
A), a low-fat, high-carbohydrate diet (
B), and dry toast for nausea (
C) are appropriate.
Question 5 of 5
A client has vertigo. Which of the following actions would be most appropriate for the nursing diagnosis of Risk for injury related to altered immobility and gait disturbances? Select all that apply.
Correct Answer: A,B,C,E
Rationale: Appropriate actions include assuming a safe position (e.g., sitting or lying down), preventing falls, performing vestibular exercises to improve balance, and keeping the head still during vertigo to minimize symptoms and reduce injury risk.