NCLEX-RN
Med Surg RN NCLEX Questions Questions
Extract:
Question 1 of 5
A client with a history of heart failure has bilateral +4 edema of her right ankle that extends up to midcalf. She is sitting out of bed and has her legs in a dependent position. Which of the following goals is the priority?
Correct Answer: A
Rationale: Bilateral edema in heart failure results from increased venous pressure and congestion due to impaired cardiac output. The priority goal is to decrease venous congestion (e.g., by elevating legs or using compression) to reduce edema and improve circulation. Respirations, temperature, and injury prevention are secondary in this context.
Question 2 of 5
Before undergoing a transsphenoidal hypophysectomy, the client asks the nurse how the surgeon will close the incision made in the dura. The nurse should respond based on the knowledge that:
Correct Answer: C
Rationale: A fascial patch is commonly used to repair the dura during transsphenoidal hypophysectomy to prevent CSF leaks.
Question 3 of 5
The client with glaucoma is scheduled for a hip replacement. Which of the following orders would require clarification before the nurse carries it out?
Correct Answer: B
Rationale: Atropine sulfate can increase intraocular pressure, which is contraindicated in glaucoma. The nurse should clarify this order to ensure it is safe for the client.
Question 4 of 5
The nurse is instructing the client about postsurgery activity following cataract surgery. What position should the nurse teach the client to use?
Correct Answer: A
Rationale: A semi-Fowler's position (head elevated 30-45 degrees) helps reduce intraocular pressure and swelling by promoting drainage and preventing fluid accumulation in the surgical eye.
Question 5 of 5
What would be the nurse's best response to the client's expressed feelings of isolation as a result of having hepatitis?
Correct Answer: D
Rationale: Encouraging the client to express feelings (
D) fosters therapeutic communication and addresses emotional needs. Dismissing feelings (A,
C) or assuming others' fears (
B) is non-therapeutic and unhelpful.