NCLEX-RN
NCLEX RN Med Surg Questions Questions
Extract:
Question 1 of 5
When teaching a client about self-care following placement of a new permanent pacemaker to his left upper chest, the nurse should include which information? Select all that apply.
Correct Answer: A,E
Rationale: Daily pulse checks (
A) monitor pacemaker function, and avoiding heavy lifting (>3 lb, E) prevents lead dislodgement. Air travel and microwaves are safe with modern pacemakers.
Question 2 of 5
Following a total hip replacement, the nurse should position the client in which of the following ways?
Correct Answer: D
Rationale: Slight abduction prevents dislocation by maintaining proper hip alignment.
Question 3 of 5
A nurse is assessing a client when she returns from same-day surgery for a dilatation and curettage. The nurse checks preoperative vital signs at 8:30 a.m. to compare them with the current vital signs at 10:30 p.m. (see chart). What should the nurse do fi rst?
Correct Answer: B
Rationale: The client’s body temperature dropped 2.5° F from the preoperative to postoperative phase. The client lost heat during the preoperative period. The client has not had time to regain the heat she has lost and should not be discharged postoperatively until her postoperative vital signs, which include body temperature, are closer to her preoperative vital signs. The client’s pulse rate, respiratory rate, and blood pressure have compensated according to the client’s hypothermic state and will refl ect changes as the client warms up. There are no indications that the client needs more pain medication, oxygen, or I.V. fl uids.
Question 4 of 5
Assessment of a client taking a nonsteroidal anti-inflammatory drug (NSAID) for pain management should include specific questions regarding which of the following systems?
Correct Answer: A
Rationale: NSAIDs commonly cause gastrointestinal side effects, such as bleeding or ulcers, so specific assessment of the GI system is critical.
Question 5 of 5
A client has advanced cirrhosis of the liver. The client's spouse asks the nurse why his abdomen is swollen, making it very difficult for him to fasten his pants. How should the nurse respond to provide the most accurate explanation of the disease process?
Correct Answer: D
Rationale: Cirrhosis causes portal hypertension and hypoalbuminemia, leading to ascites (
D). Salt intake (
A) may worsen but isn't the primary cause. Ankle edema (
B) and diuretics (
C) are secondary factors.