NCLEX-RN
Medical Surgical NCLEX RN Questions
Extract:
Question 1 of 5
A client will receive I.V. midazolam hydrochloride (Versed) during surgery. Which of the following should the nurse determine as a therapeutic effect?
Correct Answer: A
Rationale: Midazolam's primary therapeutic effect is amnesia, reducing recall of surgical events. Nausea, agitation, and blurred vision are potential side effects, not desired outcomes.
Question 2 of 5
A client is receiving Pentoxifylline (Trental) for intermittent claudication. The nurse should determine the effectiveness of the drug by asking the client:
Correct Answer: A
Rationale: Pentoxifylline improves blood flow by reducing blood viscosity and increasing erythrocyte flexibility, alleviating intermittent claudication. Asking about improved leg circulation (e.g., reduced pain or increased walking distance) assesses its effectiveness.
Toe movement, urination, and dizziness are unrelated to its therapeutic action.
Question 3 of 5
A client with ascites and peripheral edema is at risk for impaired skin integrity. To prevent skin breakdown, the nurse should:
Correct Answer: C
Rationale: An alternating air pressure mattress (
C) prevents pressure ulcers in clients with edema. ROM exercises (
A) and elevation (
D) are helpful but secondary. Abdominal massage (
B) is not indicated.
Question 4 of 5
A nurse is caring for a client who has just returned from surgery to treat a fractured mandible. Which of the following items should always be available at this client's bedside? Select all that apply.
Correct Answer: B,D
Rationale: For a client with a wired jaw due to a fractured mandible, wire cutters are essential in case of an emergency, such as vomiting, to quickly release the wires and prevent aspiration. Suction equipment is also critical to maintain a patent airway by removing secretions or vomit. A nasogastric tube, oxygen cannula, and code cart are not routinely required at the bedside unless specifically indicated.
Question 5 of 5
A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife does which of the following? Select all that apply.
Correct Answer: A,B,D,F
Rationale: Effective pain management includes around-the-clock long-acting opioids (
A), immediate-release opioids for breakthrough pain (
B), non-pharmacologic methods like music or heat/cold (
D), and using a pain scale to assess effectiveness (F). Avoiding long-acting opioids (
C) or substituting acetaminophen (E) is not appropriate for severe cancer pain.