NCLEX-RN
NCLEX RN Med Surg Questions Questions
Extract:
Question 1 of 5
A client had a mastectomy followed by chemotherapy 6 months ago. She reports that she is now 'unable to concentrate at her card game' and 'it seems harder and harder to finish her errands because of exhaustion.' Based on this information, the nurse should suggest that the client do which of the following?
Correct Answer: A
Rationale: The client's symptoms of difficulty concentrating and exhaustion suggest fatigue, which is a common long-term side effect of chemotherapy. Taking frequent naps can help manage fatigue by allowing the client to rest and conserve energy, improving her ability to perform daily activities. Limiting activities may be overly restrictive and not address the root issue, increasing fluid intake is not directly related to fatigue unless dehydration is present, and avoiding contact with others is unnecessary unless there is an infection risk.
Question 2 of 5
Which action is contraindicated for a client with a risk of increased ICP?
Correct Answer: C
Rationale: Coughing is contraindicated as it increases intracranial pressure.
Question 3 of 5
A client with type 1 diabetes is admitted to the emergency department with dehydration following the flu. The client has a blood glucose level of 325 mg/dL and a serum potassium level of 3.5 mEq. The physician has ordered 1,000 mL 5% dextrose in water to be infused every 8 hours. Prior to implementing the physician orders, the nurse should contact the physician, explain the situation, provide background information, report the current assessment of the client, and:
Correct Answer: C
Rationale: 5% dextrose in water is inappropriate for a hyperglycemic client (325 mg/dL), as it may worsen hyperglycemia. The nurse should verify the order, likely suggesting normal saline instead.
Question 4 of 5
Which of the following interventions would be the most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery?
Correct Answer: A
Rationale: Ambulation stimulates bowel motility, reducing the risk of paralytic ileus post-renal surgery by promoting gastrointestinal function.
Question 5 of 5
A client refuses to look at or care for her colostomy. Which of the following statements by the nurse would be most appropriate?
Correct Answer: D
Rationale: It is important for the nurse to recognize that individuals go through a grieving process when adjusting to a colostomy. The nurse should be accepting and provide the client with opportunities to share her concerns and feelings when she is ready. Lecturing the client about the need to learn how to care for the colostomy is not productive, nor is attempting to shame her into caring for the colostomy by implying her husband will have to provide the care if she does not. It is not possible for the nurse to understand what the client is feeling. CN: Psychosocial adaptation; CL: Synthesize