Questions 108

NCLEX-RN

NCLEX-RN Test Bank

NCLEX RN Medical Surgical Questions and Answers Questions

Extract:


Question 1 of 5

The nurse should assess a client with thrombocytopenia who has developed a hemorrhage for which of the following?

Correct Answer: A

Rationale: Hemorrhage in a client with thrombocytopenia can lead to hypovolemia, causing tachycardia as the heart compensates for decreased blood volume. Bradycardia is not typical, and while decreased urine output and hypotension may occur later, tachycardia is an earlier and more immediate sign.

Question 2 of 5

Before surgery for a known aortic aneurysm, the client's pulse pressure begins to widen, suggesting increased aortic valvular insufficiency. If the branches of the aortic arch are involved, the nurse should assess the client for:

Correct Answer: D

Rationale: Widening pulse pressure and aortic arch involvement in an aortic aneurysm suggest possible dissection affecting cerebral perfusion (e.g., carotid artery involvement), leading to disorientation or neurologic changes. Low blood pressure, anxiety, and headache are less specific or unrelated.

Question 3 of 5

A client has an amylase level of 450 units/L and lipase level of 659 units/L. The client has mid-epigastric pain with nausea. What assessment helps the nurse to determine severity of the client's condition?

Correct Answer: A

Rationale: Ranson's criteria (
A) assess pancreatitis severity using clinical and lab parameters like age, glucose, and white blood cell count. Vital signs (
B) and urine output (
C) are general but less specific. Glasgow Coma Scale (
D) is for neurological assessment, not pancreatitis severity.

Question 4 of 5

Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus. Select all that apply.

Correct Answer: A,D,E

Rationale: Obesity, especially central, is a major risk factor for complications. Carbohydrates require monitoring to manage blood glucose. Annual eye and foot exams are recommended. Insulin is not mandatory for type 2 diabetes, and exercise decreases insulin resistance.

Question 5 of 5

Which of the following has been identified as a potential risk factor for the development of colon cancer?

Correct Answer: D

Rationale: A history of inflammatory bowel disease is a risk factor for colon cancer. Other risk factors include age (older than 40 years), history of familial polyposis, colorectal polyps, and high-fat or low-fiber diet. CN: Reduction of risk potential; CL: Analyze

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