NCLEX Reduction of Risk Potential 2

Question 1

A client's serum potassium level is 6.8 mEq/L. Which finding requires the nurse's immediate attention?

Accepted Answer

Peaked T waves on the ECG

Answer

Increased urine output

Answer

Hyperactive bowel sounds

Answer

Warm, dry skin

Question 2

Before a paracentesis, which nursing action reduces the client's risk of injury?

Accepted Answer

Having the client empty the bladder

Answer

Placing the client supine and flat

Answer

Withholding all oral fluids for 24 hours

Answer

Administering a sedative routinely

Question 3

A client is scheduled for an MRI. Which item must the nurse ensure is removed or addressed?

Accepted Answer

Implanted cardiac pacemaker

Answer

Cotton hospital gown

Answer

Plastic identification band

Answer

Removable dentures

Question 4

Which lab value should the nurse review before a client receives a contrast dye CT scan?

Accepted Answer

Serum creatinine

Answer

Serum sodium

Answer

White blood cell count

Answer

Serum albumin

Question 5

A client on warfarin has an INR of 5.2. Which action does the nurse anticipate?

Accepted Answer

Holding the next warfarin dose

Answer

Administering an extra warfarin dose

Answer

Encouraging vitamin K-rich foods only

Answer

Increasing the warfarin dose

Question 6

After a liver biopsy, in which position should the nurse place the client to reduce bleeding risk?

Accepted Answer

Right side-lying with a pillow against the site

Answer

High Fowler's position

Answer

Left side-lying

Answer

Prone with arms overhead

Question 7

Which client statement before a colonoscopy indicates a need for further teaching?

Accepted Answer

"I ate a steak dinner last night."

Answer

"I drank the bowel prep solution."

Answer

"I stopped iron supplements last week."

Answer

"I arranged for a ride home."