NCLEX-RN
NCLEX RN Medical Surgical Questions Questions
Extract:
Question 1 of 5
The nurse is assessing a client with hepatitis and notices that the AST and ALT levels have increased. Which of the following statements by the client requires further instruction by the nurse?
Correct Answer: D
Rationale: Acetaminophen (
D) is hepatotoxic and should be avoided in hepatitis due to increased liver enzyme levels. Rest (
A), a low-fat, high-carbohydrate diet (
B), and dry toast for nausea (
C) are appropriate.
Question 2 of 5
The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate?
Correct Answer: D
Rationale: Jaundice (
D) is a common early sign of cirrhosis due to impaired bilirubin metabolism. Peripheral edema (
A) and ascites (
B) occur later. Anorexia (
C) is less specific.
Question 3 of 5
Which of the following interventions should the nurse anticipate incorporating into the client's plan of care when hepatic encephalopathy initially develops?
Correct Answer: D
Rationale: A low-protein diet (
D) reduces ammonia production in hepatic encephalopathy. NG tubes (
A), fluid restriction (
B), and albumin (
C) are not primary interventions.
Question 4 of 5
The client who has been hospitalized with pancreatitis does not drink alcohol because of her religious convictions. She becomes upset when the physician persists in asking her about alcohol intake. The nurse should explain that the reason for these questions is that:
Correct Answer: A
Rationale: Alcohol is a primary cause of acute pancreatitis, so questioning its use (
A) is essential to identify etiology. Interference with tests (
B), general alcoholism screening (
C), or disregarding beliefs (
D) are not accurate explanations.
Question 5 of 5
The nurse is planning care for a client being admitted with bleeding esophageal varices. Vital signs are: Pulse 100; respiratory rate 22; and blood pressure 100/58. The nurse should prepare the client for which of the following? Select all that apply.
Correct Answer: A,B,C,D
Rationale: Octreotide (
A) reduces portal pressure, endoscopy (
B) diagnoses/treats bleeding, blood products (
C) address hypovolemia, and Minnesota tube (
D) controls bleeding. TIPS (E) is a later intervention, not immediate.