Questions 108

NCLEX-RN

NCLEX-RN Test Bank

Medical Surgical NCLEX RN Questions

Extract:


Question 1 of 5

When the nurse enters the client's room, the nurse perceives that the client is staring straight ahead. Which of the following is the best course of action for the nurse to take next?

Correct Answer: C

Rationale: Listening to the client and observing body language allows the nurse to assess the client's condition and needs, considering macular degeneration may cause the client to appear to stare straight ahead due to central vision loss.

Question 2 of 5

The nurse explains to the client with pain that the purpose of biofeedback is to enable him to exert control over his physiologic processes by:

Correct Answer: D

Rationale: Biofeedback translates physiological signals (e.g., heart rate) into observable forms, allowing the client to control them consciously. It does not involve electrical shocks, therapist interpretation, or direct electrical regulation.

Question 3 of 5

The nurse monitors the client with pancreatitis for early signs of shock. Which of the following conditions is primarily responsible for making it difficult to manage shock in pancreatitis?

Correct Answer: B

Rationale: Fluid sequestration into the retroperitoneal space (
B) causes significant hypovolemia in pancreatitis, complicating shock management. Intestinal hemorrhage (
A), infection (
C), and cardiac output (
D) are secondary or less common contributors.

Question 4 of 5

The nurse is caring for a client who has had a gastroscopy. Which of the following signs and symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply.

Correct Answer: C,D

Rationale: Epigastric pain and hematemesis after a gastroscopy may indicate complications such as perforation or bleeding. A sore throat and drowsiness are expected post-procedure effects due to throat irritation and sedation.

Question 5 of 5

A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg; PaCO2, 28 mm Hg; HCO3ˆ’, 24 mEq/L. The nurse determines that which of the following is a possible cause for these findings?

Correct Answer: D

Rationale: The ABG shows respiratory alkalosis (high pH, low PaCO2) and severe hypoxia (PaO2 50). Pulmonary embolus causes hypoxia and hyperventilation, matching these findings. COPD causes CO2 retention. Ketoacidosis causes metabolic acidosis. Myocardial infarction is less likely to cause this pattern.

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