NCLEX-RN
NCLEX RN Med Surg Questions Questions
Extract:
Question 1 of 5
The nurse is assisting a client who has had a spinal fusion apply a back brace. In which order of priority should the nurse assist the client applying the brace?
Correct Answer: B,A,D,C
Rationale: Verifying the order ensures correct settings, side-lying positions the client safely, log rolling prevents twisting, and standing allows proper brace fitting.
Question 2 of 5
A 92-year-old male client who is independent and lives alone has an inguinal hernia repair. Which teaching method is the best approach to use for his postoperative and discharge instructions?
Correct Answer: C
Rationale: Demonstration and return demonstration is the most effective for an elderly client, as it ensures understanding and ability to perform postoperative care tasks, accommodating potential sensory or cognitive limitations.
Question 3 of 5
Initial treatment for a cerebrospinal fluid (CSF) leak after transsphenoidal hypophysectomy would most likely involve:
Correct Answer: C
Rationale: Bed rest with head elevation reduces pressure on the surgical site, promoting healing of a CSF leak.
Question 4 of 5
A client has recently been diagnosed with type 2 diabetes mellitus and is to take tolbutamide (Orinase). When teaching the client about the drug, the nurse explains that tolbutamide is believed to lower the blood glucose level by which of the following actions?
Correct Answer: C
Rationale:
Tolbutamide, a sulfonylurea, stimulates insulin release from pancreatic beta cells, helping to lower blood glucose levels in type 2 diabetes.
Question 5 of 5
The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8°F (38.8°C). What should the nurse do in response to this reported assessment data?
Correct Answer: A
Rationale: A sudden fever after an upper GI endoscopy may indicate a serious complication, such as perforation, requiring immediate nursing assessment. The other options delay appropriate intervention or do not address the potential severity of the situation.