NCLEX-RN
NCLEX RN Medical Surgical Questions Questions
Extract:
Question 1 of 5
When assessing the lower extremities of a client with peripheral vascular disease (PVD), the nurse notes bilateral ankle edema. The edema is related to:
Correct Answer: C
Rationale: Bilateral ankle edema in PVD is often due to increased venous pressure from venous insufficiency or right-sided heart failure, which impairs venous return and causes fluid to pool in the lower extremities. Decreased blood volume or increased muscular activity does not cause edema, and arterial pressure is not directly related.
Question 2 of 5
The nurse is developing a plan of care for a client with Crohn's disease who is receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include? Select all that apply.
Correct Answer: B,C,D,E
Rationale: For a client on TPN, daily weight monitoring (
B), daily dressing changes (
C), hourly infusion rate checks (
D), and securing tubing connections (E) are critical to prevent complications like infection or fluid imbalance. Vital signs once a shift (
A) is insufficient; more frequent monitoring is needed. CN: Pharmacological and parenteral therapies; CL: Create
Question 3 of 5
The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to:
Correct Answer: B
Rationale: Cardiac catheterization in unstable angina assesses the extent of coronary artery blockage to guide interventions like angioplasty or bypass surgery.
Question 4 of 5
The nurse is planning care with a client with acute leukemia who has mucositis. The nurse should advise the client that after every meal and every four hours while awake the client should use:
Correct Answer: C
Rationale: Mucositis in leukemia clients requires gentle oral care to prevent infection and promote healing. Saline or baking soda solution is soothing and non-irritating. Lemon-glycerin swabs can dry the mucosa, commercial mouthwash may irritate, and brushing may cause trauma.
Question 5 of 5
The nurse notices a pair of nervous-acting individuals entering the emergency department. When reporting suspicious activity, the nurse should include which of the following in the report? Select all that apply.
Correct Answer: A,B
Rationale: Reporting suspicious activity should include objective details like vehicle description and current location to aid security response. Names, relationships, and tone are less critical unless directly relevant.