NCLEX-PN Test-Bank 200 Questions with Answers and Explanation Latest Update Guaranteed A+
- The nurse is caring for a client scheduled for removal of a pituitary tumor using the
transsphenoidal approach. The nurse should be particularly alert for:
- Nasal congestion
- Abdominal tenderness
- Muscle tetany
- Oliguria
- A client with cancer is admitted to the oncology unit. Stat lab values reveal Hgb 12.6,
- Hypernatremia
- Hypokalemia
- Myelosuppression
- Leukocytosis
Answer A: Removal of the pituitary gland is usually done by a transsphenoidal approach, through the nose. Nasal congestion further interferes with the airway. Answers B, C, and D are not correct because they are not directly associated with the pituitary gland.
WBC 6500, K+ 1.9, uric acid 7.0, Na+ 136, and platelets 178,000. The nurse evaluates that the client is experiencing which of the following?
Answer B: Hypokalemia is evident from the lab values listed. The other laboratory findings are within normal limits, making answers A, C, and D
incorrect. 1 / 4
- A 24-year-old female client is scheduled for surgery in the morning. Which of the
- Taking the vital signs
- Obtaining the permit
- Explaining the procedure
- Checking the lab work
- The nurse is working in the emergency room when a client arrives with severe burns of
- Starting an IV
- Applying oxygen
- Obtaining blood gases
- Medicating the client for pain
following is the primary responsibility of the nurse?
Answer A: The primary responsibility of the nurse is to take the vital signs before any surgery.The actions in answers B, C, and D are the responsibility of the doctor and, therefore, are incorrect for this question.
the left arm, hands, face, and neck. Which action should receive priority?
Answer B: The client with burns to the neck needs airway assessment and supplemental oxygen, so applying oxygen is the priority. The next action should be to start an IV and medicate for pain, making answers A and C incorrect. Answer D, obtaining blood gases, is ordered by the doctor.
- The nurse is visiting a home health client with osteoporosis. The client has a new
- Rest in bed after taking the medication for at least 30 minutes
- Avoid rapid movements after taking the medication 2 / 4
prescription for alendronate (Fosamax). Which instruction should be given to the client?
- Take the medication with water only
- Allow at least 1 hour between taking the medicine and taking other medications
- The nurse is making initial rounds on a client with a C5 fracture and crutchfield tongs.
- A pair of forceps
- A torque wrench
- A pair of wire cutters
- A screwdriver
- An infant weighs 7 pounds at birth. The expected weight by 1 year should
Answer B: The client with burns to the neck needs airway assessment and supplemental oxygen, so applying oxygen is the priority. The next action should be to start an IV and medicate for pain, making answers A and C incorrect. Answer D, obtaining blood gases, is ordered by the doctor.
Which equipment should be kept at the bedside?
Answer B: A torque wrench is kept at the bedside to tighten and loosen the screws of crutchfield tongs. This wrench controls the amount of pressure that is placed on the screws. A pair of forceps, wire cutters, and a screwdriver, in answers A, C, and D, would not be used and, thus, are incorrect.
be:
- 10 pounds
- 12 pounds
- 18 pounds
- 21 pounds 3 / 4
Answer D: A birth weight of 7 pounds would indicate 21 pounds in 1 year, or triple his birth weight. Answers A, B, and C therefore are incorrect.
- A client is admitted with a Ewing’s sarcoma. Which symptoms would be expected due to
- Hemiplegia
- Aphasia
- Nausea
- Bone pain
- The nurse is caring for a client with epilepsy who is being treated with carbamazepine
- Uric acid of 5mg/dL
- Hematocrit of 33%
this tumor’s location?
Answer D: Sarcoma is a type of bone cancer; therefore, bone pain would be expected. Answers A, B, and C are not specific to this type of cancer and are incorrect.
(Tegretol). Which laboratory value might indicate a serious side effect of this drug?
- WBC 2,000 per cubic millimeter
- Platelets 150,000 per cubic millimeter
- A 6-month-old client is admitted with possible intussuception. Which question during
- / 4
Answer C: Tegretol can suppress the bone marrow and decrease the white blood cell count; thus, a lab value of WBC 2,000 per cubic millimeter indicates side effects of the drug. Answers A and D are within normal limits, and answer B is a lower limit of normal; therefore, answers A, B, and D are incorrect.
the nursing history is least helpful in obtaining information regarding this diagnosis?