NCLEX-RN
Medical Surgical Nursing NCLEX RN Questions Questions
Extract:
Question 1 of 5
Which of the following client statements identifies a knowledge deficit about cast care?
Correct Answer: C
Rationale: Pulling out cast padding can cause skin irritation or pressure sores, indicating a knowledge deficit.
Question 2 of 5
Which of the following home care instructions would be appropriate for a client with a laryngectomy?
Correct Answer: B
Rationale: Adequate humidity prevents stoma crusting and maintains airway moisture. Mouth care frequency may need to be higher. Diet should be tailored to swallowing ability, not necessarily soft or bland. Physical activity should be encouraged, not limited, unless contraindicated.
Question 3 of 5
Vasopressin (Pitressin) is administered to the client with diabetes insipidus because it:
Correct Answer: B
Rationale: Vasopressin increases water reabsorption in the kidneys, reducing urine output in diabetes insipidus.
Question 4 of 5
At 8 a.m., the nurse reviews the amount of T-tube drainage for a client who underwent an open cholecystectomy yesterday. After reviewing the output record (see chart), the nurse should:
Correct Answer: C
Rationale: The T-tube should drain approximately 300 to 500 mL in the fi rst 24 hours and after 3 to 4 days the amount should decrease to less than 200 mL in 24 hours. With the sudden decrease in drainage at 8 a.m., the nurse should immediately assess the tube for obstruction of flow that can be caused by kinks in the tube or the client lying on the tube. Drainage color must also be assessed for signs of bleeding. The tube should not be irrigated or clamped without an order.
Question 5 of 5
A client has renal colic due to renal lithiasis. What is the nurse's first priority in managing care for this client?
Correct Answer: D
Rationale: Severe pain from renal colic is the priority, requiring opioid analgesics for immediate relief to improve client comfort and cooperation.