NCLEX-RN
NCLEX RN Medical Surgical Questions and Answers Questions
Extract:
Question 1 of 5
A client with Crohn's disease has concentrated urine, decreased urinary output, dry skin with decreased: decreased turgor, hypotension, and weak, thready pulses. The nurse should do which of the following first?
Correct Answer: B
Rationale: The client's symptoms indicate dehydration, requiring immediate parenteral rehydration therapy as ordered to restore fluid balance. Oral fluids, repositioning, or monitoring are less urgent or inappropriate as the first action. CN: Physiological adaptation; CL: Synthesize
Question 2 of 5
The nurse sees a client walking in the hallway who begins to have a seizure. The nurse should do which of the following in priority order?
Order the Items
Source Container
Correct Answer: C,A,B,D
Rationale: The priority order is: 1) Ease the client to the floor to prevent injury (
C); 2) Maintain a patent airway to ensure oxygenation (
A); 3) Record seizure activity for accurate reporting (
B); 4) Obtain vital signs post-seizure to assess stability (
D).
Question 3 of 5
The nurse asks the client to state her name as soon as she regains consciousness postoperatively after a subtotal thyroidectomy and at each assessment. The nurse does this to monitor for signs of which of the following?
Correct Answer: C
Rationale: Asking the client to speak monitors for laryngeal nerve damage, which can cause vocal cord paralysis and hoarseness, a potential complication of thyroidectomy.
Question 4 of 5
A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD?
Correct Answer: B
Rationale: In COPD, high oxygen concentrations may suppress the hypoxic drive to breathe, risking CO2 retention. Oxygen does not cause coughing, dependency, or contraindication with bronchodilators.
Question 5 of 5
The nurse is assessing an older adult's skin. The assessment will involve inspecting the skin for color, pigmentation, and vascularity. The critical component in the nurse's assessment is noting the:
Correct Answer: B
Rationale: Noting changes from normal findings is critical, as it helps identify abnormalities like lesions or discoloration that may indicate pathology, beyond expected age-related changes.