NCLEX-RN
Medical Surgical NCLEX RN Questions
Extract:
Question 1 of 5
A client with cirrhosis begins to develop ascites. Spironolactone (Aldactone) is prescribed to treat the ascites. The nurse should monitor the client closely for which of the following drug-related adverse effects?
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic, so hyperkalemia (
B) is a key adverse effect. Constipation (
A), irregular pulse (
C), and dysuria (
D) are not typical.
Question 2 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 3 of 5
The nurse monitors the client with pancreatitis for early signs of shock. Which of the following conditions is primarily responsible for making it difficult to manage shock in pancreatitis?
Correct Answer: B
Rationale: Fluid sequestration into the retroperitoneal space (
B) causes significant hypovolemia in pancreatitis, complicating shock management. Intestinal hemorrhage (
A), infection (
C), and cardiac output (
D) are secondary or less common contributors.
Question 4 of 5
The nurse has an order to administer 2 oz of lactulose (Cephulac) to a client who has cirrhosis. How many milliliters of lactulose should the nurse administer?
Correct Answer: 60 mL
Rationale: 2 oz equals 60 mL (1 oz = 30 mL), so the nurse should administer 60 mL of lactulose (
A).
Question 5 of 5
Which of the following medications should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy?
Correct Answer: B
Rationale: Calcium gluconate is used to treat tetany by correcting hypocalcemia, which causes muscle spasms and tingling.