Enalapril maleate is prescribed for a hospitalized client. Which assessment does the nurse perform as a priority before administering the medication? - Answer-Checking the client's blood pressure
Enalapril maleate is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. One...
NCLEX Comprehensive Exam Questions
and Answers
Enalapril maleate is prescribed for a hospitalized client. Which assessment does the
nurse perform as a priority before administering the medication? - Answer-Checking the
client's blood pressure
Enalapril maleate is an angiotensin-converting enzyme (ACE) inhibitor used to treat
hypertension. One common side effect is postural hypotension. Therefore the nurse
would check the client's blood pressure immediately before administering each dose.
Checking the client's peripheral pulses, the results of the most recent potassium level,
and the intake and output for the previous 24 hours are not specifically associated with
this mediation.
A client is scheduled to undergo an upper gastrointestinal (GI) series, and the nurse
provides instructions to the client about the test. Which statement by the client indicates
a need for further instruction? - Answer-"I need to drink citrate of magnesia the night
before the test and give myself a Fleet enema on the morning of the test."
An upper GI series involves visualization of the esophagus, duodenum, and upper
jejunum by means of the use of a contrast medium. It involves swallowing a contrast
medium (usually barium), which is administered in a flavored milkshake. Films are taken
at intervals during the test, which takes about 30 minutes. No special preparation is
necessary before a GI series, except that NPO status must be maintained for 8 hours
before the test. After an upper GI series, the client is prescribed a laxative to hasten
elimination of the barium. Barium that remains in the colon may become hard and
difficult to expel, leading to fecal impaction.
A nurse on the evening shift checks a health care provider's prescriptions and notes that
the dose of a prescribed medication is higher than the normal dose. The nurse calls the
health care provider's answering service and is told that the health care provider is off
for the night and will be available in the morning. The nurse should: - Answer-Ask the
answering service to contact the on-call health care provider
An emergency department (ED) nurse is monitoring a client with suspected acute
myocardial infarction (MI) who is awaiting transfer to the coronary intensive care unit.
The nurse notes the sudden onset of premature ventricular contractions (PVCs) on the
monitor, checks the client's carotid pulse, and determines that the PVCs are not
resulting in perfusion. The appropriate action by the nurse is: - Answer-Asking the ED
health care provider to check the client
NPO status is imposed 8 hours before the procedure on a client scheduled to undergo
electroconvulsive therapy (ECT) at 1 p.m. On the morning of the procedure, the nurse
checks the client's record and notes that the client routinely takes an oral
antihypertensive medication each morning. The nurse should: - Answer-Administer the
antihypertensive with a small sip of water
, A client who recently underwent coronary artery bypass graft surgery comes to the
health care provider's office for a follow-up visit. On assessment, the client tells the
nurse that he is feeling depressed. Which response by the nurse is therapeutic? -
Answer-"Tell me more about what you're feeling."
A client in labor experiences spontaneous rupture of the membranes. The nurse
immediately counts the fetal heart rate (FHR) for 1 full minute and then checks the
amniotic fluid. The nurse notes that the fluid is yellow and has a strong odor. Which
action should be the nurse's priority? - Answer-Contacting the health care provider
A nurse has assisted a health care provider in inserting a central venous access device
into a client with a diagnosis of severe malnutrition who will be receiving parenteral
nutrition (PN). After insertion of the catheter, the nurse immediately plans to: - Answer-
Call the radiography department to obtain a chest x-ray
A rape victim being treated in the emergency department says to the nurse, "I'm really
worried that I've got HIV now." What is the appropriate response by the nurse? -
Answer-"Let's talk about the information that you need to determine your risk of
contracting HIV."
A client is taking prescribed ibuprofen , 300 mg orally four times daily, to relieve joint
pain resulting from rheumatoid arthritis. The client tells the nurse that the medication is
causing nausea and indigestion. The nurse should tell the client to: - Answer-Take the
medication with food
A client's oral intake of liquids includes 120 mL on the night shift, 800 mL on the day
shift, and 650 mL on the evening shift. The client is receiving an intravenous (IV)
antibiotic every 12 hours, diluted in 50 mL of normal saline solution. The nurse empties
700 mL of urine from the client's Foley catheter at the end of the day shift. Thereafter,
500 mL of urine is emptied at the end of the evening shift and 325 mL at the end of the
night shift. Nasogastric tube drainage totals 155 mL for the 24-hour period, and the total
drainage from the Jackson-Pratt device is 175 mL. What is the client's total intake
during the 24-hour period? - Answer-1670
The client's 24-hour total oral intake is 1570 mL, and the IV intake totals 100 mL (50 mL
of normal saline solution every 12 hours). Therefore the 24-hour intake total is 1670 mL.
Lorazepam 1 mg by way of intravenous (IV) injection (IV push) is prescribed for a client
for the management of anxiety. The nurse prepares the medication as prescribed and
administers the medication over a period of: - Answer-3 minutes
A nurse, conducting an assessment of a client being seen in the clinic for symptoms of
a sinus infection, asks the client about medications that he is taking. The client tells the
nurse that he is taking nefazodone hydrochloride . On the basis of this information, the
nurse determines that the client most likely has a history of: - Answer-depression
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