NCLEX-RN
Medical Surgical NCLEX RN Questions
Extract:
Question 1 of 5
A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. Which is the nurse's best response?
Correct Answer: B
Rationale: Pernicious anemia results from a lack of intrinsic factor, a gastric protein necessary for vitamin B12 absorption. This necessitates lifelong B12 injections, as oral supplements are ineffective. The other responses are incorrect, as stomach acid, kidney dysfunction, or increased B12 demand are not the primary causes.
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 is instructing a client with COPD how to do pursed-lip breathing. In which order should the nurse explain the steps to the client?
Order the Items
Source Container
Correct Answer: B,A,C,D
Rationale: The correct order for pursed-lip breathing is: relax muscles (
B), inhale through nose for 2 counts (
A), pucker lips (
C), exhale through pursed lips for 4 counts (
D). This prolongs exhalation, reducing air trapping.
Question 4 of 5
A client with terminal cancer is transitioning to hospice care. The nurse should prioritize which of the following in the care plan?
Correct Answer: A
Rationale: Aggressive pain management is the priority in hospice care to ensure comfort and quality of life for a client with terminal cancer.
Question 5 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.