NCSBN TEST BANK - FOR THE NCLEX-RN & NCLEX-PN, UPDATED 2021, COMPLETE QUESTIONS & ANSWERS WITH RATIONALE

NCSBN TEST BANK - FOR THE NCLEX-RN &
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NCLEX-PN, UPDATED 2021, G G




G COMPLETEQUESTIONS & ANSWERS WITH G G G G




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Question 1 G




The nurse is caring for a 4 year-old who will have surgery
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G for Tetralogy of Fallot tomorrow. Which laboratory report
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G must receive PRIORITY attention by the nurse?
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A) Erythrocyte sedimentation rate G G




B) White blood cell count
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C) Hemoglobin and hematocrit G G




D) Arterial blood gases G G




Review Information: The correct answer is:
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C) Hemoglobin and hematocrit.
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Tetralogy of Fallot is a cyanotic heart defect, which can
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G manifest in polycythemia due to release of erythropoietin.
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,G Hemoglobin valuesof up to 20 and hematocrit''s of 60 or
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G higher may be seen. These must be noted and reported to
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G the physician.
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Question 2 G




The nurse is assessing a client with portal hypertension.
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G Which of the following findings would the nurse expect?
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A) Expiratory wheezes G




B) Blurred vision G




C) Acites


D) Dilated pupils G




Review Information: The correct answer is:
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C) Acites.
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Portal hypertension can occur in a client with right-sided
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heart failure or cirrhosis of the liver. Portal hypertension
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G can lead to acites due to the increased protal pressure as
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G well as a lowered osmotic pressure.
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,Question 3 G




A 67 year-old client with non-insulin dependent diabetes
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G should be instructed to contact the out-patient clinic
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G IMMEDIATELY if the following symptoms are present
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A) Temperature of 37.5 degrees C with painful urination
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B) An open wound on their heel
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C) Insomnia and daytime fatigueG G G




D) Nausea with two episodes of vomiting
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Review Information: The correct answer is:
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B) An open wound on their heel.
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When signs of infection occur in their feet, elderly clients
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G who have diabetes and/or vascular disease should seek
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G health care quickly and continue treatment until the
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G infection is resolved. Without treatment, serious infection,
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G gangrene, limb loss, and death may result.
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, Question 4 G




The nurse is assessing a newborn the day after birth. The
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G following are noted: high pitched cry, irritability and lack
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G of interest in feeding. The mother signed her own
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G discharge against medical advice. Which of the following is
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G APPROPRIATE nursing care? G G




A) Reduce the environmental stimuli
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B) Offer formula every 2 hours
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C) Talk to the newborn while feeding
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D) Rock the baby frequently
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Review Information: The correct answer is:
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A) Reduce the environmental stimuli.
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This newborn appears to be withdrawing from substances
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G taken by the mother before its birth. Reducing noise and
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