NCLEX-RN Quiz #2 A client is admitted with a diagnosis of pneumonia. Which intervention should the nurse include in the plan of care? A) Encourage fluid intake of at least 2,500 mL/day
B) Place the client in a supine position
C) Limit the client’s activity level
D) Provide a high-fat, low-protein diet
Show Answer Correct Answer: Encourage fluid intake of at least 2,500 mL/day
What is the primary concern for a client with a potassium level of 2.8 mEq/L? A) Seizures
B) Dysrhythmias
C) Diarrhea
D) Muscle weakness
Show Answer Correct Answer: Dysrhythmias
Which of the following is the most accurate method to verify nasogastric (NG) tube placement? A) Auscultating for air insufflation
B) Checking pH of gastric aspirate
C) Observing gastric contents
D) Assessing client tolerance
Show Answer Correct Answer: Checking pH of gastric aspirate
A client is prescribed warfarin for atrial fibrillation. What is the priority teaching point? A) Take the medication on an empty stomach
B) Report any signs of bleeding immediately
C) Increase intake of leafy green vegetables
D) Avoid strenuous activity
Show Answer Correct Answer: Report any signs of bleeding immediately
A nurse is preparing to administer digoxin. Which assessment is the priority before administration? A) Blood pressure
B) Heart rate
C) Respiratory rate
D) Level of consciousness
Show Answer Correct Answer: Heart rate
What is the priority nursing action for a client experiencing autonomic dysreflexia? A) Administer antihypertensive medication
B) Elevate the client’s head
C) Insert a Foley catheter
D) Loosen restrictive clothing
Show Answer Correct Answer: Elevate the client’s head
A client with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse observes the client becoming drowsy and lethargic. What is the most likely cause? A) Hypercapnia
B) Hypoxia
C) Hyperventilation
D) Electrolyte imbalance
Show Answer Correct Answer: Hypercapnia
Which of the following is the best position for a client experiencing hypovolemic shock? A) Semi-Fowler's position
B) Supine with legs elevated
C) Prone position
D) High Fowler's position
Show Answer Correct Answer: Supine with legs elevated
A nurse is caring for a client with a new tracheostomy. What is the priority intervention? A) Change the tracheostomy ties daily
B) Suction as needed to maintain a patent airway
C) Perform tracheostomy care every 12 hours
D) Monitor for signs of infection
Show Answer Correct Answer: Suction as needed to maintain a patent airway
A client receiving total parenteral nutrition (TPN) develops sudden diaphoresis and shakiness. What should the nurse do first? A) Check the client’s blood glucose
B) Stop the TPN infusion
C) Administer dextrose 50% IV
D) Notify the healthcare provider
Show Answer Correct Answer: Check the client’s blood glucose