NCLEX-RN V12.35 (1) (865 Q & A) ALL ANSWERS 100%
CORRECT SATISFACTION GUARANTEED SUCCESS
LATEST UPDATE 2026/2025 RATED A+
NO.1 Prior to his discharge from the hospital, a cardiac client is started on digoxin
(Lanoxin) 25 mg po qd. The nurse initiates discharge teaching. Which of the
following statements by the client would validate an understanding of his
medication?
A. "I would notify my physician immediately if I experience nausea, vomiting, and double
vision."
B. "I could stop taking this medication when I begin to feel better."
C. "I should only take the medication if my heart rate is greater than 100 bpm."
D. "I should always take this medication with an antacid."
Answer: A
Explanatio
n:
(A) The first signs of digoxin toxicity include abdominal pain, anorexia, nausea,
vomiting, and visual disturbances. The physician should be notified if any of these
symptoms are experienced. (B) The positive inotropic effects of digoxin increase
cardiac output and result in an enhanced activity tolerance. "Feeling better" indicates
the drug is working and medication therapy must be continued.
(C) Clients should be taught to take their pulse prior to taking the digoxin. If their
pulse rate becomes irregular, slows significantly, or is >100 bpm the physician should
be notified. (D) Antacids decrease the effectiveness of digoxin.
NO.2
,A woman diagnosed with multiple sclerosis is disturbed with diplopia. The nurse will
teach her to:
A. Limit activities which require focusing (close vision)
B. Take more frequent naps
C. Use artificial tears
D. Wear a patch over one eye
Answer: D
Explanatio
n:
(A)
Limiting activities requiring close vision will not alleviate the discomfort of
double vision. (B)
Frequent naps may be comforting, but they will not prevent double vision. (C)
Artificial tears are necessary in the absence of a corneal reflex, but they have no
effect on diplopia.
(D)
An eye patch over either eye will eliminate the effects of double vision during the time
the eye patch is worn. An eye patch is safe for a person with an intact corneal reflex.
NO.3 A client is medically cleared for ECT and is tentatively scheduled for six nts
over a 2- week period. Her husband asks, "Isn't that a lot?" The nurse's best
response is:
A. "Yes, that does seem like a lot."
B. "You'll have to talk to the doctor about that. The physician knows what's best for the
client."
C. "Six to 10 treatments are common. Are you concerned about permanent effects?"
D. "Don't worry. Some clients have lots more than that."
Answer: C
,Explanatio
n:
(A) This response indicates that the nurse is unsure of herself and not
knowledgeable about ECT. It also reinforces the husband's fears. (B) This response is
"passing the buck" unnecessarily. The information needed to appropriately answer
the husband's question is well within the nurse's knowledge base. (C) The most
common range for affective disorders is 6-10 treatments. This response confirms
and reinforces the physician's plan for treatment. It also opens communicationwith
the husband to identify underlying fears and knowledge deficits. (D) This response
offers false reassurance and dismisses the husband's underlying concerns about his
wife.
NO.4 A client with IDDM is given IV insulin for a blood glucose level of 520 mg/dL. Life-
threatening complications may occur initially, so the nurse will monitor him closely for
serum:
A. Chloride level of 99 mEq/L
B. Sodium level of 136 mEq/L
C. Potassium level of 3.1 mEq/L
D. Potassium level of 6.3 mEq/L
Answer: D
Explanatio
n:
(A) The chloride level is within acceptable limits. (B) The sodium level is within
acceptable limits. (C) This value indicates hypokalemia, rather than the hyperkalemia
that occurs during diabetic ketoacidosis. (D) When diabetic ketoacidosis exists,
intracellular dehydration occurs and potassium leaves the cells and enters the vascular
system, thus increasing the serum level beyond an acceptable range. When insulin and
fluids are administered, cell walls are repaired and potassium is transported back into
the cells. Normal serum potassium levels range from 3.5-5.0 mEq/L.
, NO.5 A 27-year-old primigravida at 32 weeks' gestation has been diagnosed with
complete placenta previa. Conservative management including bed rest is the proper
medical management. The goal for fetal survival is based on fetal lung maturity. The
test used to determine fetal lung maturity is:
A. Dinitrophenylhydrazine
B. Metachromatic stain
C. Blood serum phenylalanine test
D. Lecithin-sphingomyelin ratio
Answer: D
Explanatio
n:
(A) Dinitrophenylhydrazine is a laboratory test used to detect phenylketonuria, maple
syrup urine disease, and Lowe's syndrome. (B) Metachromatic stain is a laboratory test
that may be used to diagnose Tay-Sachs and other lipid diseases of the central nervous
system. (C) The blood serum phenylalanine test is diagnostic of phenylketonuria and
can be used for wide-scale screening. (D) A lecithin-sphingomyelin ratio of at least 2:1
is indicative of fetal lung maturity, and survival of the fetus is likely.
NO.6 One week ago, a 21-year-old client with a diagnosis of bipolar disorder was
started on lithium 300 mg po qid. A lithium level is ordered. The client's level is 1.3
mEq/L. The nurse recognizes that this level is considered to be:
A. Within therapeutic range
B. Below therapeutic range
C. Above therapeutic range
D. At a level of toxic poisoning
Answer: A
Explanatio
n:
CORRECT SATISFACTION GUARANTEED SUCCESS
LATEST UPDATE 2026/2025 RATED A+
NO.1 Prior to his discharge from the hospital, a cardiac client is started on digoxin
(Lanoxin) 25 mg po qd. The nurse initiates discharge teaching. Which of the
following statements by the client would validate an understanding of his
medication?
A. "I would notify my physician immediately if I experience nausea, vomiting, and double
vision."
B. "I could stop taking this medication when I begin to feel better."
C. "I should only take the medication if my heart rate is greater than 100 bpm."
D. "I should always take this medication with an antacid."
Answer: A
Explanatio
n:
(A) The first signs of digoxin toxicity include abdominal pain, anorexia, nausea,
vomiting, and visual disturbances. The physician should be notified if any of these
symptoms are experienced. (B) The positive inotropic effects of digoxin increase
cardiac output and result in an enhanced activity tolerance. "Feeling better" indicates
the drug is working and medication therapy must be continued.
(C) Clients should be taught to take their pulse prior to taking the digoxin. If their
pulse rate becomes irregular, slows significantly, or is >100 bpm the physician should
be notified. (D) Antacids decrease the effectiveness of digoxin.
NO.2
,A woman diagnosed with multiple sclerosis is disturbed with diplopia. The nurse will
teach her to:
A. Limit activities which require focusing (close vision)
B. Take more frequent naps
C. Use artificial tears
D. Wear a patch over one eye
Answer: D
Explanatio
n:
(A)
Limiting activities requiring close vision will not alleviate the discomfort of
double vision. (B)
Frequent naps may be comforting, but they will not prevent double vision. (C)
Artificial tears are necessary in the absence of a corneal reflex, but they have no
effect on diplopia.
(D)
An eye patch over either eye will eliminate the effects of double vision during the time
the eye patch is worn. An eye patch is safe for a person with an intact corneal reflex.
NO.3 A client is medically cleared for ECT and is tentatively scheduled for six nts
over a 2- week period. Her husband asks, "Isn't that a lot?" The nurse's best
response is:
A. "Yes, that does seem like a lot."
B. "You'll have to talk to the doctor about that. The physician knows what's best for the
client."
C. "Six to 10 treatments are common. Are you concerned about permanent effects?"
D. "Don't worry. Some clients have lots more than that."
Answer: C
,Explanatio
n:
(A) This response indicates that the nurse is unsure of herself and not
knowledgeable about ECT. It also reinforces the husband's fears. (B) This response is
"passing the buck" unnecessarily. The information needed to appropriately answer
the husband's question is well within the nurse's knowledge base. (C) The most
common range for affective disorders is 6-10 treatments. This response confirms
and reinforces the physician's plan for treatment. It also opens communicationwith
the husband to identify underlying fears and knowledge deficits. (D) This response
offers false reassurance and dismisses the husband's underlying concerns about his
wife.
NO.4 A client with IDDM is given IV insulin for a blood glucose level of 520 mg/dL. Life-
threatening complications may occur initially, so the nurse will monitor him closely for
serum:
A. Chloride level of 99 mEq/L
B. Sodium level of 136 mEq/L
C. Potassium level of 3.1 mEq/L
D. Potassium level of 6.3 mEq/L
Answer: D
Explanatio
n:
(A) The chloride level is within acceptable limits. (B) The sodium level is within
acceptable limits. (C) This value indicates hypokalemia, rather than the hyperkalemia
that occurs during diabetic ketoacidosis. (D) When diabetic ketoacidosis exists,
intracellular dehydration occurs and potassium leaves the cells and enters the vascular
system, thus increasing the serum level beyond an acceptable range. When insulin and
fluids are administered, cell walls are repaired and potassium is transported back into
the cells. Normal serum potassium levels range from 3.5-5.0 mEq/L.
, NO.5 A 27-year-old primigravida at 32 weeks' gestation has been diagnosed with
complete placenta previa. Conservative management including bed rest is the proper
medical management. The goal for fetal survival is based on fetal lung maturity. The
test used to determine fetal lung maturity is:
A. Dinitrophenylhydrazine
B. Metachromatic stain
C. Blood serum phenylalanine test
D. Lecithin-sphingomyelin ratio
Answer: D
Explanatio
n:
(A) Dinitrophenylhydrazine is a laboratory test used to detect phenylketonuria, maple
syrup urine disease, and Lowe's syndrome. (B) Metachromatic stain is a laboratory test
that may be used to diagnose Tay-Sachs and other lipid diseases of the central nervous
system. (C) The blood serum phenylalanine test is diagnostic of phenylketonuria and
can be used for wide-scale screening. (D) A lecithin-sphingomyelin ratio of at least 2:1
is indicative of fetal lung maturity, and survival of the fetus is likely.
NO.6 One week ago, a 21-year-old client with a diagnosis of bipolar disorder was
started on lithium 300 mg po qid. A lithium level is ordered. The client's level is 1.3
mEq/L. The nurse recognizes that this level is considered to be:
A. Within therapeutic range
B. Below therapeutic range
C. Above therapeutic range
D. At a level of toxic poisoning
Answer: A
Explanatio
n:
