NCLEX-RN
Med Surg RN NCLEX Practice Questions Questions
Extract:
Question 1 of 5
When caring for a client with a central venous line, which of the following nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply.
Correct Answer: A,B,D,E
Rationale: Verifying patency (
A), inspecting the site (
B), repositioning for no blood return (
D), and contacting the provider if placement is questionable (E) are critical to ensure safe chemotherapy administration. Administering without blood return (
C) risks extravasation and tissue damage.
Question 2 of 5
A 20-year-old who hit his head while playing football has a tonic-clonic seizure. Upon awakening from the seizure, the client asks the nurse, "What caused me to have a seizure? I've never had one before." Which cause should the nurse include in the response as a primary cause of tonic-clonic seizures in adults older than age 20?
Correct Answer: A
Rationale: Head trauma is a primary cause of seizures in adults over 20, especially in the context of a recent injury. Electrolyte imbalances, congenital defects, or epilepsy are less likely without additional history.
Question 3 of 5
The nurse should monitor the client with Cushing's disease for which of the following?
Correct Answer: B
Rationale: Hypokalemia is common in Cushing's disease due to aldosterone excess, causing potassium loss.
Question 4 of 5
A client with a hemorrhagic stroke is slightly agitated, heart rate is 118, respirations are 22, bilateral rhonchi are auscultated, SpO2 is 94%, blood pressure is 144/88, and oral secretions are noted. What order of interventions should the nurse follow when suctioning the client to prevent increased intracranial pressure (ICP) and maintain adequate cerebral perfusion?
Order the Items
Source Container
Correct Answer: B,D,A,C
Rationale: The correct order is: 1) Hyperoxygenate to prevent hypoxia (
B); 2) Provide sedation to reduce agitation and ICP spikes (
D); 3) Suction the airway to clear secretions (
A); 4) Suction the mouth to remove residual secretions (
C). This sequence minimizes ICP increases and ensures oxygenation.
Question 5 of 5
When teaching a client with chronic obstructive pulmonary disease to conserve energy, the nurse should teach the client to lift the patient.
Correct Answer: B
Rationale: Lifting while exhaling through pursed lips conserves energy by aligning effort with prolonged exhalation, reducing air trapping in COPD. Other methods increase respiratory workload.