NCLEX-RN
NCLEX RN Medical Surgical Practice Questions Questions
Extract:
Question 1 of 5
A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would have the threshold to be removed.
Correct Answer: D
Rationale: Encouraging nonverbal or written expression allows the client to process emotions despite speech loss, addressing psychological needs. Discussing with his wife breaches confidentiality. Exploring future plans may be premature. Respecting privacy may reinforce withdrawal.
Question 2 of 5
The nurse evaluates that the client correctly understands how to report signs and symptoms of bleeding when the client makes which of the following statements?
Correct Answer: B
Rationale: Ecchymoses are large, purple bruises caused by bleeding under the skin, a common sign of thrombocytopenia. This statement shows correct understanding. Petechiae are small, pinpoint red dots, not large bruises; 'emmum' is not a medical term; and abrasions are superficial skin injuries, not bleeding signs.
Question 3 of 5
The nurse formulates a nursing diagnosis of Spiritual distress related to advanced cancer disease. An appropriate goal for the client would be to:
Correct Answer: D
Rationale: Participating in spiritual activities of the client's choice respects their individual beliefs and supports resolution of spiritual distress.
Question 4 of 5
A client undergoing a mastectomy asks why she needs to sign a blood transfusion consent form. The nurse's best response is:
Correct Answer: A
Rationale: Explaining that the consent is a precaution for potential bleeding addresses the client's question accurately and promotes informed consent.
Question 5 of 5
After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse correctly interprets these findings as indicating which of the following?
Correct Answer: C
Rationale: Sudden pain and inability to move suggest joint dislocation, a surgical emergency.