NCLEX RN Medical Surgical Practice Questions
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Question 1 of 5.
The primary healthcare provider (PHCP) prescribes 200 mg of doxycycline to be administered over one hour. The pharmacy supplies the medication in a bag labeled 200 mg of doxycycline in 150 mL of 0.9% saline. How many drops per minute should the nurse set the flow rate at? Fill in the blank. Round your answer to the nearest whole number.
Answer: A
Explanation: To calculate the flow rate: Total volume = 150 mL, time = 60 minutes, drop factor (standard) = 10 gtts/mL. Flow rate = (150 mL × 10 gtts/mL) ÷ 60 min = 1500 ÷ 60 = 25 gtts/min. However, re-evaluating with a common drop factor of 15 gtts/mL (as some IV sets use): (150 × 15) ÷ 60 = 2250 ÷ 60 = 37.5, rounded to 38 gtts/min. Given the answer provided is 42, it may assume a different drop factor (e.g., 16.67 gtts/mL), but 42 is accepted as the provided answer.
Question 2 of 5.
A client with chest pain is prescribed intravenous nitroglycerin (Tridil). Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip?
A. Serum potassium is 3.5 mEq/L.
B. Blood pressure is 88/46.
C. ST elevation is present on the electrocardiogram.
D. Heart rate is 61.
Explanation: Nitroglycerin causes vasodilation, which can lower blood pressure. A blood pressure of 88/46 indicates hypotension, a significant concern as it may compromise perfusion, making it the priority assessment.
Question 3 of 5.
The nurse is assessing a client who has had a myocardial infarction. The nurse notes the cardiac rhythm shown on the electrocardiogram strip below. The nurse identifies this rhythm as which of the following?
A. Atrial fibrillation.
B. Ventricular tachycardia.
C. Premature ventricular contractions.
D. Sinus tachycardia.
Explanation: Sinus tachycardia is a fast but regular rhythm originating from the sinoatrial node, typically occurring in response to factors like pain, fever, anxiety, or myocardial infarction.
Question 4 of 5.
A 68-year-old female client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The first nursing action should be to:
A. Inquire about the onset, duration, severity, and precipitating factors of the heaviness.
B. Administer oxygen via nasal cannula.
C. Offer pain medication for the chest heaviness.
D. Inform the physician of the chest heaviness.
Explanation: Assessing the characteristics of chest heaviness clarifies whether it is cardiac (e.g., angina) or non-cardiac, guiding further actions like oxygen or physician notification.
Question 5 of 5.
A client has a history of heart failure and has been taking several medications, including furosemide (Lasix), digoxin (Lanoxin) and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of which condition?
A. Hyperkalemia.
B. Digoxin toxicity.
C. Fluid deficit.
D. Pulmonary edema.
Explanation: Nausea, blurred vision, confusion, and AV block are classic signs of digoxin toxicity, especially in a client taking digoxin, requiring immediate assessment.
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