NCLEX Review Study Guide Comprehensive Questions and Answers 100%Accuracy | Updated 2024.
A client with diabetes mellitus calls the clinic nurse and rep... [Show More] orts that she has been
vomiting during the night and now has diarrhea. Which question does the nurse
make a priority of asking the client? - Answer- "Have you tested your blood
glucose?"
A client's oral intake of liquids includes 120 mL on the night shift, 800 mL on the day
shift, and 650 mL on the evening shift. The client is receiving an intravenous (IV)
antibiotic every 12 hours, diluted in 50 mL of normal saline solution. The nurse
empties 700 mL of urine from the client's Foley catheter at the end of the day shift.
Thereafter, 500 mL of urine is emptied at the end of the evening shift and 325 mL at
the end of the night shift. Nasogastric tube drainage totals 155 mL for the 24-hour
period, and the total drainage from the Jackson-Pratt device is 175 mL. What is the
client's total intake during the 24-hour period? - Answer- 1670mL
A client with heart failure suddenly experiences profound dyspnea, pallor, audible
wheezing, and cyanosis, and the nurse suspects pulmonary edema. The nurse
would first: - Answer- Raise the head of the client's bed
A client with cervical cancer who is undergoing chemotherapy with cisplatin
(Platinol). For which adverse effect of cisplatin will the nurse assess the client? -
Answer- Hearing loss
Alendronate (Fosamax) is prescribed for a client with postmenopausal osteoporosis.
The nurse provides information on the medication to the client. When does the nurse
tell the client to take the alendronate? - Answer- Every morning before breakfast,
with a full glass of water
A client with emphysema is receiving theophylline (Theo-24). While providing dietary
instructions, the nurse tells the client that it is acceptable to consume: - AnswerApple juice
A nurse is reviewing the record of a client scheduled for electroconvulsive therapy
(ECT). Which of the following diagnoses, if noted on the client's record, would
indicate a need to contact the physician who is scheduled to perform the ECT? -
Answer- Recent stroke
An emergency department nurse is assessing a client with acute closed-angle
glaucoma. Which of the following characteristics of the disorder does the nurse
expect the client to exhibit? Select all that apply. - Answer- Nausea
Eye pain
Vomiting
Headache
NCLEX Review Study Guide Comprehensive Questions
and Answers 100%Accuracy | Updated 2024
The nurse administers intravenous morphine sulfate to a client in pulmonary edema.
For which intended effect of the medication does the nurse monitor the client? -
Answer- Relief of anxiety
An emergency department nurse is told that a client with carbon monoxide poisoning
resulting from a suicide attempt is being brought to the hospital by emergency
medical services. Which intervention will the nurse carry out as a priority upon arrival
of the client? - Answer- Administering 100% oxygen
A client with agoraphobia will undergo systematic desensitization through graduated
exposure. In explaining the treatment to the client, the nurse tells the client that this
technique involves: - Answer- Gradually introducing the client to a phobic object or
situation in a predetermined sequence of least to most frightening
A client with a medical history of diabetes mellitus is found to have sarcoidosis, and
oral prednisone is prescribed. The nurse provides instructions to the client about the
medication and tells the client to: - Answer- Closely monitor the blood glucose level
Enalapril maleate (Vasotec) is prescribed for a hospitalized client. Which
assessment does the nurse perform as a priority before administering the
medication? - Answer- Checking the client's blood pressure
A client who has undergone abdominal hysterectomy asks the nurse when she will
be able to resume sexual intercourse. The nurse tells the client that sexual
intercourse may be resumed: - Answer- In about 6 weeks, when the vaginal vault is
satisfactorily healed
A nurse on the evening shift checks a physician's prescriptions and notes that the
dose of a prescribed medication is higher than the normal dose. The nurse calls the
physician's answering service and is told that the physician is off for the night and will
be available in the morning. The nurse should: - Answer- Ask the answering service
to contact the on-call physician
A hospitalized female client with mania enters the unit community room and says to
a client who is wearing a blue shirt, "Boys in blue are fun to do! Boys in blue are fun
to do!" What is the appropriate response by the nurse? - Answer- "Don't say that. If
you can't control yourself, we'll help you."
A client with HIV infection who has been found to have histoplasmosis is being
treated with intravenous amphotericin B (Fungizone). Which parameter does the
nurse check to detect the most common adverse effect of this medication? - AnswerIntake and output
A nurse is gathering subjective and objective data from a client with suspected
rheumatoid arthritis (RA). Which early manifestations of RA would the nurse expect
to note? Select all that apply. - Answer- Fatigue
Low-grade fever
Phenelzine sulfate (Nardil) is prescribed for a client with depression. The nurse
provides information to the client about the adverse effects of the medication and
tells the client to contact the physician immediately if she experiences: - AnswerNeck stiffness or soreness
A client is receiving an intravenous infusion of oxytocin (Pitocin) to stimulate labor.
The nurse monitoring the client notes uterine hypertonicity and immediately: -
Answer- Stops the oxytocin infusion
A nurse is assessing a pregnant woman for the presence of edema. The nurse
places a thumb on the top of the client's foot, then exerts pressure and releases it
and notes that the thumb has left a persistent depression. On the basis of this
finding, the nurse concludes that: - Answer- Pitting edema is present
A nurse is caring for a client with community-acquired pneumonia who is being
treated with levofloxacin (Levaquin). For which of the following findings, indicating an
adverse reaction to the medication, does the nurse monitor the client? - AnswerFever
A client receiving parenteral nutrition (PN) suddenly experiences chest pain and
dyspnea, and the nurse suspects an air embolism. The nurse immediately places the
client in a lateral Trendelenburg position, on the left side. What action does the nurse
take next? - Answer- Clamping the intravenous catheter
A nurse is preparing a poster for a health fair booth promoting primary prevention of
skin cancer. Which of the following recommendations does the nurse include on the
poster? Select all that apply. - Answer- Seek medical advice if you find a skin lesion.
A nurse is providing instructions to a client with glaucoma who will be using
acetazolamide (Diamox) daily. Which of the following findings, an adverse effect,
does the nurse instruct the client to report to the physician? - Answer- Dark urine
A nurse is providing morning care to a client who has undergone surgery to repair a
fractured left hip. Which item is most important for the nurse to use in turning the
client from side to side to change the bed linens? - Answer- Abduction device . [Show Less]