NCLEX NGN Pre-Test QuestionsStudy online at nurse is assigned to care for a client with chron-ic renal failure who is undergoing hemodialysis through an internal AV fistula in the RA. Which intervention should the nurse implement in caring for the client?

NCLEX NGN Pre-Test QuestionsStudy online at https://quizlet.com/_cm8qtd1.A nurse is assigned to care for a client with chron-ic renal failure who is undergoing hemodialysis through an internal AV fistula in the RA. Which intervention should the nurse implement in caring for the client? SATAa. Assessing the radial pulse in the right extremityb. Using the LA ti take BP readingsc. Drawing pre-dialysis blood specimens from the LAd. Assessing the area over the AV fistula for a bruit and three each shifte. Placing a pressure dressing over the site after each dialysis treatmentf. Administering IV fluids through the venous site of the AV fistula as neededA, B, C, D2.A nurse is evaluating outcomes for a client with Guillain-Barre syndrome. Which outcome does the nurse recognize as optimal respiratory outcomes for the client?a. Normal deep tendon reflexesb. Improved skeletal muscle tonec. Absences of paresthesias in the lower extremi-tiesd. Clear sound in the lower lung fields bilaterallye. pO2 of 85 mmHg and pCO2 of 40 mmHgD, E3.A nurse of the telemetry unit is caring for a client who has had a MI and is now attached to a cardiac monitor. The nurse is monitoring the client's car-diac rhythm and nots ventricular fibrillation. Which nursing intervention should the nurse take first?a. Calling the rapid response teamb. Preparing the client for cardioversionc. Asking the client to bear down and coughd. Preparing to administer diltiazemAThe pattern of ventric-ular fibrillation is iden-tified and can be a result after a patient with an MI. VF makes the patient feel faint, then loses conscious-ness and becomes pulseless and apneic (BP and heart sounds absent). Treatment is 1 / 25

NCLEX NGN Pre-Test QuestionsStudy online at https://quizlet.com/_cm8qtdto terminate VF and covert it into a rhythm via defibrillation-> call a rapid and initi-ate CPR. Cardiover-sion is used for ventric-ular or supraventricu-lar tachydysrhythmias.4.A nurse developing a plan of care for a client with a spinal cord injury includes measures to pre-vent autonomic dysreflexia (hyperreflexia). Which intervention does the nurse incorporate into the plan to prevent this complication?a. Keeping the fan running in the client's roomb. Keeping the linens wrinkle free under the clientc. Limiting bladder catheterization to once every 12 hoursd. Avoiding the administration of enemas and rec-tal suppositoriesBThe most frequent cause of autonomic dysreflexias are a dis-tended bladder and impacted feces. Other causes include stim-ulation of the skin by tactile, thermal, or painful stimuli. The nurse renders care in such a way as to mini-mize these risks.5.A nurse provides home care instructions to a client who has been fitted with a halo device to treat a cervical fracture. Which statement by the client indicates the need for further teaching?a. I need to get more fluids and fiber into my dietb. I should cut my food into small pieces before I eatc. I need to put powder under the vest twice a day to prevent sweatingd. I have to check the pin sites everyday and watch for signs of infectionCCleanse the skin un-der the wool liner each day to prevent rashes and soars.6.A nurse is caring for a client with increased in-tracranial pressure. In which position should the nurse maintain the client?a. Supine with the head extendedDProper positioning promotes venous 2 / 25

NCLEX NGN Pre-Test QuestionsStudy online at https://quizlet.com/_cm8qtdb. Side lying with the neck flexedc. Supine with the head turned to the sided. Head midline and elevated 30-45 degreesdrainage from the cra-nium to minimize ICP.7.A client with a basilar skull fracture has clear fluid leaking from the ears. The nurse should take which action first?a. Asses the clear fluid for proteinb. Check the clear fluid for glucosec. Place cotton calls or dry gauze loosely in the earsd. Use an otoscope to assess the tympanic mem-brane for ruptureBCSF contains glucose not protein.8.A nurse is caring for a client who has just un-dergone cardioversion. Which intervention is the nurse's priority after this procedure. a. Administer oxygenb. Monitoring the BPc. Administering antidysrhythmic medicationsd. Monitoring the client's LOCAABC's of nursing. All other choices are cor-rect, but not priority.9.A client with diabetes mellitus who is scheduled to have blood drawn for determination of the glyco-sylated hemoglobin (HbA1c) level asks the nurse why the test is necessary if he is performing blood glucose monitoring at home. Which is the best response for the nurse to provide?a. Detect diabetic complicationsb. Assess long-term glycemic controlc. Determine whether the client is at risk for hypo-glycemiad Determine whether the prescribed insulin dosage is correctB10.A nurse caring for a client with acquired immun-odeficiency syndrome is monitoring the client for signs of complications. Which of the following would cause the nurse to suspect infection with Pneumocystis jirovec? SATAB, D, EA opportunistic res-piratory infection as-sociated with AIDs that causes dys-3 / 25

NCLEX NGN Pre-Test QuestionsStudy online at https://quizlet.com/_cm8qtda. Diarrheab. Tachypneac. Pedal edemad. Intermittent fevere. Dyspnea with ambulatingf. Expectoration of frothy mucuspnea, nonproductive cough, intermittent fever, fatigue, anorex-ia, tachypnea, wt. loss.11.Zidovudine is prescribed for a client with AIDS. The nurse tells the client that it is important to report back to the clinic as scheduled for which follow-up diagnostic?a. Blood glucose checksb. Blood pressure checksc. Complete blood counts (CBC)d. Electrocradiographic studiesCZidovudine is an an-tiviral medication that cause cause agranulo-cytosis and anemia.12.After a non-immunocompromised client under-goes a Mantoux test for TB infection, an area of induration 6 mm wide developed. The client asks the nurse what this result means. Which is the best response?a. We'll have to repeat the test because the result was inconclusiveb. The swollen area is small, so that means your test result is negativec. You've been exposed to TB so you will need to have a chest x-rayd. You need to get started on medication right away because you have TBBIndurations less than 10 mm (non-immuno-compromised) and 5 mm (immunocompro-mised) is considered a negative result af-ter 48-72 hrs. Re-sults greater indicate exposure and possi-ble TB infection. Morse testing (x-ray) will be needed.13.A clients arterial blood gases are analyzed; pH 1.49, paO2 97 mmHg, HCO3- 22 mEq/L. Which acid base balance disturbance does the nurse identify from these results?a. Metabolic acidosisb. Metabolic alkalosisc. Respiratory acidosisd. Respiratory alkalosisDRAcidosis: paCo2 >45 mmHg and RAlkalo-sis is paCo2 <35 mmHg. MAcidosis is HCO3- is less than 22 mEq/L and MAlkalosis is HCO3- greater than 26 mEq/L.4 / 25