NCLEX-RN
Medical Surgical Nursing NCLEX RN Questions Questions
Extract:
Question 1 of 5
The client with colon cancer has an abdominal-perineal resection with a colostomy. Which of the following nursing interventions is most appropriate for this client in the postoperative period?
Correct Answer: B
Rationale: Appropriate nursing interventions after an abdominal-perineal resection with a colostomy include assisting the client with warm sitz baths three to four times a day to clean the perineal incision. The client will be more comfortable assuming a side-lying position because of the perineal incision. It would be inappropriate to administer milk of magnesia to stimulate colostomy activity. Stool passage will begin as peristalsis returns. It is not necessary to be available to change the ostomy pouch to assess the stoma. The ostomy pouch should be transparent to allow easy observation of the stoma and drainage. CN: Physiological adaptation; CL: Synthesize
Question 2 of 5
It is the night before a client is to have a computed tomography (CT) scan of the head without contrast. The nurse should tell the client?
Correct Answer: D
Rationale: Holding the head still during a CT scan is essential to obtain clear images. Shampooing, fasting, or shaving hair for electrodes are not required for a non-contrast head CT.
Question 3 of 5
The nurse should tell the client to do which of the following when teaching the client about taking oral glucocorticoids?
Correct Answer: D
Rationale: Taking glucocorticoids with meals or an antacid reduces gastrointestinal irritation, a common side effect.
Question 4 of 5
Which of the following interventions should the nurse anticipate in a client who has been diagnosed with acute respiratory distress syndrome (ARDS)?
Correct Answer: C
Rationale: ARDS with severe hypoxemia typically requires mechanical ventilation to support oxygenation and ventilation. Tracheostomy is considered later. Nasal cannula is inadequate. Chest tubes are for pneumothorax, not ARDS.
Question 5 of 5
The nurse is evaluating the client's learning about combination chemotherapy. Which of the following statements by the client about reasons for using combination chemotherapy indicates the need for further explanation?
Correct Answer: B
Rationale: Combination chemotherapy targets cancer cells at different cell cycle stages, reduces resistance, and minimizes toxicity by using lower doses of multiple drugs. It does not treat side effects; supportive care does. This statement indicates a need for further explanation.