Questions 108

NCLEX-RN

NCLEX-RN Test Bank

NCLEX RN Med Surg Questions Questions

Extract:


Question 1 of 5

A client is receiving an I.V. infusion of 5% dextrose in water (D5W). The skin around the I.V. insertion site is red, warm to touch, and painful. The nurse should first:

Correct Answer: C

Rationale: Redness, warmth, and pain at the I.V. site indicate phlebitis or infiltration. The first action is to discontinue the I.V. to prevent further tissue damage. Changing fluids, applying a compress, or giving acetaminophen does not address the immediate issue.

Question 2 of 5

The nurse is assessing a client with anemia. In order to plan nursing care, the nurse should focus the assessment on which of the following?

Correct Answer: C

Rationale: Cold intolerance is a common symptom of anemia due to reduced oxygen-carrying capacity, and assessing it helps plan supportive care.

Question 3 of 5

Which symptom suggests a complication post-renal surgery?

Correct Answer: A

Rationale: Low urine output (25 mL/hour) may indicate obstruction or renal impairment.

Question 4 of 5

A client has a Pearson attachment on the traction setup. What is the purpose of this attachment?

Correct Answer: A

Rationale: The Pearson attachment supports the lower leg, maintaining alignment in balanced suspension traction.

Question 5 of 5

The client who experiences angina has been told to follow a low-cholesterol diet. Which of the following meals should the nurse tell the client would be best on her low-cholesterol diet?

Correct Answer: C

Rationale: Spaghetti with tomato sauce, salad, and coffee is low in cholesterol, unlike hamburger, liver, or fried chicken, which contain higher cholesterol or saturated fats.

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