NCLEX review

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Which of the following is a late sign of increased ICP in this child?

Bradycardia

A client has clear fluid leaking from the nose after a basilar skull fracture. The nurse determines that this is cerebrospinal fluid (CSF) if the fluid:

Separates into concentric rings and tests positive for glucose

A client with tuberculosis (TB) asks a nurse about precautions to take after discharge from the hospital to prevent transmitting infection of others. The nurse develops a response to the client's question, based on the understanding that:

The disease is transmitted by droplet nuclei.

A nurse is teaching the client with a below-the-knee amputation (BKA) measures to protect the residual limb, or stump. The nurse would be sure to include which of the following points in discussions with the client?

Use a mirror to inspect all areas of the residual limb.

A client with severe preeclampsia is receiving magnesium sulfate by intravenous infusion. The nurse reviews the laboratory results, knowing that which value is a therapeutic magnesium level?

6 mg/dL

A hospitalized client is newly diagnosed with diabetes mellitus. The client must take both NPH and Regular insulin for glucose control. The nurse develops a teaching plan to help the client meet which outcome as a first step in managing the disease?

Adjust insulin according to capillary blood glucose levels.

A nurse in the preoperative holding unit administers a dose of scopolamine to a client. The nurse monitors the client for which common side effect of the medication?

Dry mouth

A nurse is assigned to care for a client who has experienced uterine rupture. The nurse plans care knowing that which of the following is the priority concern in caring for the client?

Impaired gas exchange

A mother is breast-feeding her newborn infant. The mother complains to the nurse that she is experiencing severe nipple soreness. The nurse should provide which of the following suggestions to the client?

Position the newborn infant with the ear, shoulder, and hip in straight alignment and with the baby's stomach against the mother's

A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client. Before administering the medication, the nurse reviews the action of the medication and understands that it:

Releases sodium ions in exchange for primarily potassium ions

A nurse is preparing to reposition a dependent client who weighs more than 250 pounds. What intervention is best for the nurse to consider when moving this client?

get help

A client in skeletal leg traction with an overbed frame is not allowed to turn from side to side. Which action by the nurse would be most useful in trying to provide good skin care to the client?

Asking the client to pull up on a trapeze to lift the hips off the bed

A client who is taking theophylline (Theo-24) reports to the health care clinic as scheduled to have a serum theophylline level drawn. The blood is drawn and the laboratory calls the nurse and reports the results as 10 mcg/mL. The client asks the nurse what this figure means. The nurse accurately responds by stating this level is:

At the low end of the therapeutic range

A client who has received sodium bicarbonate in large amounts is at risk for developing metabolic alkalosis. The nurse checks this client for which signs and symptoms characteristic of this disorder?

Decreased respiratory depth and rate and dysrhythmias

A nurse is assisting in the care of a client who is being evaluated for possible myasthenia gravis. The health care provider gives a test dose of edrophonium (Enlon). The nurse recalls that the client would have which of the following reactions if the client actually does have this disease

An increase in muscle strength within 1 to 3 minutes


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