NCLEX RN Medical Surgical Questions and Answers
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Question 1 of 5.
The nurse in the emergency department is administering an order for 20 mg intravenous furosemide (Lasix) which is to be given immediately. The nurse seems the client's identification and the medication barcode. The medication administration system does not verify that furosemide is ordered for this client; however, the furosemide is prepared in the accurate unit dose for intravenous infusion. The nurse should do which of the following next?
A. Contact the pharmacist immediately to check the order and the barcode label for accuracy.
B. Administer the medication now, knowing the medication is labeled and the client is identified.
C. Report the problem to the information technology team to have the barcode system recalibrated.
D. Ask another nurse to verify the medication and the client so the medication can be given now.
Explanation: A barcode verification failure indicates a potential error, requiring immediate pharmacist consultation to confirm the order and ensure patient safety.
Question 2 of 5.
The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive the highest priority?
A. BP 110/62, atrial fibrillation with HR 82, bibasilar crackles.
B. Confusion, urine output 15 mL over the last 2 hours, orthopnea.
C. SpO2 92 on 2 liters nasal cannula, respirations 20, 1+ edema of lower extremities.
D. Weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with exercise.
Explanation: Confusion, low urine output, and orthopnea indicate severe heart failure with potential cerebral and renal hypoperfusion, requiring immediate intervention. Other options reflect stable or less urgent findings.
Question 3 of 5.
Which of the following reflects the principle on which a client's diet will most likely be based during the acute phase of myocardial infarction?
A. Liquids as desired.
B. Small, easily digested meals.
C. Three regular meals per day.
D. Nothing by mouth.
Explanation: Small, easily digested meals reduce the metabolic demand on the heart and prevent gastrointestinal distress, which could exacerbate myocardial oxygen demand during the acute phase of MI.
Question 4 of 5.
Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician?
A. A change in the pattern of her pain.
B. Pain during sexual activity.
C. Pain during an argument with her husband.
D. Pain during or after an activity such as lawn-mowing.
Explanation: A change in the pattern of angina pain may indicate worsening ischemia or progression to unstable angina or MI, requiring immediate medical attention.
Question 5 of 5.
A client receiving a loop diuretic should be encouraged to eat which of the following foods? Select all that apply.
A. Angel food cake.
B. Banana.
C. Dried fruit.
D. Orange juice.
E. Peppers.
Explanation: Loop diuretics like furosemide cause potassium loss. Bananas (B), dried fruit (C), and orange juice (D) are potassium-rich, helping prevent hypokalemia.
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