Questions 108

NCLEX-RN

NCLEX-RN Test Bank

Free NCLEX RN Questions for Med Surg Questions

Extract:


Question 1 of 5

A client with acute respiratory distress syndrome (ARDS) has fine crackles at lung bases and the respirations are shallow at a rate of 28 breaths/minute. The client is restless and anxious. In addition to monitoring the arterial blood gas results, the nurse should do which of the following? Select all that apply.

Correct Answer: C,D

Rationale: Administering humidified oxygen (
C) improves oxygenation in ARDS. Auscultating lungs (
D) monitors crackles and ventilation. Creatinine/BUN monitoring is unrelated to acute respiratory status. Sedatives may depress respiration.

Question 2 of 5

The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

Correct Answer: D

Rationale: Elevated myoglobin indicates myocardial damage, as it is released from injured cardiac muscle, supporting a diagnosis of MI.

Question 3 of 5

A client who has had her jaws wired begins to vomit. What should be the nurse's first action?

Correct Answer: C

Rationale: Suctioning the airway is the first action to prevent aspiration in a client with wired jaws who is vomiting. Cutting the wires is a last resort, and the other options do not address the immediate risk of airway obstruction.

Question 4 of 5

Assessment of the diabetic client for common complications should include examination of the:

Correct Answer: D

Rationale: Diabetic retinopathy, a common complication, requires regular eye examinations to detect and prevent vision loss.

Question 5 of 5

A nurse is assessing a client with heart failure. The nurse should assess the client based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply.

Correct Answer: A,B,C,D,E

Rationale: Heart failure activates the sympathetic nervous system (
A), renin-angiotensin-aldosterone system (
B), myocardial hypertrophy (
C), natriuretic peptide release (
D), and ventricular dilation (E) to compensate for reduced cardiac output.

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