NCLEX-RN
NCLEX RN Questions Medical Surgical Nursing Questions
Extract:
Question 1 of 5
The client with a laryngectomy is being discharged. The nurse should determine that the client understands to do which of the following self-care measures? Select all that apply.
Correct Answer: A,B,C
Rationale: Self-care measures include home humidification to keep the airway moist, using a stoma shield during bathing to prevent water entry, and consuming 2-3 L/day of fluids to maintain hydration. Spicy foods and low-fiber diets are not typically restricted.
Question 2 of 5
When instructing a client who has been newly diagnosed with vasospastic disorder (Raynaud's phenomenon) about management of care, the nurse should discuss which of the following topics?
Correct Answer: C
Rationale: Raynaud's phenomenon is often associated with connective tissue diseases (e.g., scleroderma, lupus), especially secondary Raynaud's. Discussing follow-up monitoring for these conditions is essential for early detection and management. Sympathectomy, beta blockers, and angioplasty are not first-line or relevant interventions.
Question 3 of 5
The client with a spinal cord injury asks the nurse why the dietitian has recommended to decrease the total daily intake of calcium. Which of the following responses by the nurse would provide the most accurate information?
Correct Answer: C
Rationale: Immobility leads to bone demineralization, increasing calcium release and risk of hypercalcemia.
Question 4 of 5
Which of the following discharge instructions would be appropriate for a client who has had a laparoscopic cholecystectomy?
Correct Answer: B
Rationale: Returning to work within 1 week (
B) is reasonable for laparoscopic cholecystectomy, depending on recovery. Showering is typically allowed after 24-48 hours (A is incorrect). Dressings can often be removed sooner (
C), and acetaminophen is for pain, not fever control (
D).
Question 5 of 5
The client tells the nurse that since his diagnosis of stomach cancer, he has been having trouble sleeping and is frequently preoccupied with thoughts about how his life will change. He says, 'I wish my life could stay the same.' Based on this information, which one of the following nursing diagnoses would be appropriate at this time?
Correct Answer: C
Rationale: The client's statement and symptoms suggest grieving related to the life-altering diagnosis of stomach cancer. This diagnosis best captures the emotional response to the anticipated changes.