NEW GENERATION NGN NCLEX RN EXAM

NEW GENERATION (NGN) NCLEX RN EXAM

2022-2023 ACTUAL EXAM TEST BANK 500

QUESTIONS AND CORRECT DETAILED

ANSWERS WITH RATIONALES (VERIFIED

ANSWERS) |ALREADY GRADED A+

An elderly client with chronic kidney disease is admitted with urosepsis.Based on the admitting diagnosis and laboratory results, which prescriptions would the nurse question? Select all that apply. Click on the exhibit button for additional information.

• Continue home dose of valsartan

-Chronic kidney disease impairs the excretion of excess potassium and can potentiate hyperkalemia, which can lead to life-threatening arrhythmias (eg, ventricular fibrillation). ACE inhibitors (eg, lisinopril, ramipril) or angiotensin II receptor blockers (eg, valsartan, losartan, irbesartan) can be used to manage hypertension secondary to renal disease; however, these drugs can worsen hyperkalemia

• Obtain CT scan of abdomen with contrast

• Clients with chronic kidney disease and elevated creatinine are

unable to excrete the iodinated contrast administered for CT scans.Toxic effects from the contrast can occur; therefore, this prescription should be clarified before the scan. 1 / 4

Urosepsis is a type of bloodstream infection that originates from the urinary tract. The initial treatment of sepsis focuses on the management or prevention of septic shock, mainly by administering boluses of isotonic IV fluids (fluid resuscitation) and IV broad-spectrum antibiotics (Option 1). Blood and urine cultures are obtained, ideally before the first dose of antibiotics (Option 4). Continuous vital sign and cardiac telemetry monitoring are initiated as hyperkalemia (high potassium of 6.5) and sepsis cause cardiovascular disturbances (eg, dysrhythmias and hypotension, respectively)

While the nurse and unlicensed assistive personnel are turning an intubated and heavily sedated client during a bath, the client coughs and expels the endotracheal tube. What is the priority nursing action?

• Deliver rescue breathing with a bag-valve-mask attached to 100%

oxygen

If a client is accidentally extubated, the nurse should remain with the client, protect the airway using the head-tilt chin-lift or the jaw- thrust maneuver if spinal injury is suspected, and deliver breaths using a bag-valve-mask with 100% oxygen until reintubation is achieved (Option 2).

Code blue should only be initiated if cardiac arrest occurs 2 / 4

A client is at 28 weeks gestation with suspected preeclampsia. Which of the following signs/symptoms indicate that the client has developed this syndrome? Select all that apply.

• Epigastric pain
• Headaches and blurry vision
• Proteinuria

Preeclampsia is a multisystem disorder that can occur during pregnancy and is defined as new-onset hypertension and proteinuria or signs of end-organ damage. Cerebral symptoms (eg, headache, visual changes) from severe hypertension and/or epigastric pain secondary to decreased liver perfusion and hepatic damage can occur. Pregnancy causes an intravascular volume expansion larger than the rise in the number of red blood cells, resulting in hemodilution.

The nurse is performing a medication reconciliation during a clinic visit with a client recently prescribed lithium. Which of the client's home medications is the priority to clarify with the health care provider?

• Hydrochlorothiazide 3 / 4

Lithium is a mood stabilizer most often used to treat bipolar affective disorders. Lithium has a very narrow therapeutic index (0.8-1.2 mEq/L [0.8-1.2 mmol/L]) that should be closely monitored; it also has the potential for many drug interactions. Several medications can cause increased lithium levels, including thiazide diuretics (eg, hydrochlorothiazide), nonsteroidal anti-inflammatory drugs, and antidepressants. Thiazide diuretics have demonstrated the greatest potential to increase lithium concentrations, with a possible 25%-40% increase in concentrations (Option 2). The nurse should assess the client for signs and symptoms of lithium toxicity and report the findings to the health care provider.

Four pediatric clients are brought to the emergency department at the same time. Which client should be seen first?

• Child with bruising behind the ears after a football injury

Bruising behind the ear (eg, Battle sign) following head trauma may indicate a basilar skull fracture (Option 3). Because of their close proximity to the brainstem, basilar skull fractures pose a risk of serious intracranial injury, which is the most common cause of traumatic death in children. Other signs include blood behind the tympanic membrane, periorbital hematomas (ie, raccoon eyes), and cerebrospinal fluid leakage from the nose or ears. This client requires cervical spine immobilization, close neurologic monitoring, and support of airway, breathing, and circulation.

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