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NCLEX-RN ACTUAL EXAM TEST
QUESTIONS & ANSWERS VERIFIED 100%
CORRECT
Which action should be included in the nursing care for a
client with cervical cancer who has an internal radium
implant in place?
Offer the bedpan every 2 hours.
Provide perineal care twice daily.
Check the position of the applicator hourly.
Offer a low-residue diet. - ANSWER-Bowel movements
can be difficult with the radium applicator in place. The
purpose of the low-residue diet is to decrease bowel
movements. The bowel is cleaned before therapy, and the
woman is maintained on a lowresidue diet during
treatment to prevent bowel distention and defecation. To
prevent dislodgment of the applicator, the client is
maintained on strict bed rest and allowed only to turn
from side to side. Perineal care is omitted during radium
implant therapy, although any vaginal discharge should be
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reported to the health care provider (HCP). It is rare for
the applicator to extrude, so this does not need to be
checked every hour.
A breastfeeding mother who is experiencing breast
engorgement asks the nurse if there is anything she can
do to get relief. What is the best intervention for the nurse
to implement? applying ice applying a breast binder
teaching how to express the breasts administering
bromocriptine - ANSWER-Teaching the client how to
express her breasts will facilitate let-down, and provide
temporary relief. Ice can promote comfort by decreasing
blood flow, numbing, and discouraging further let-down
of milk. It is not recommended because it also causes the
rebound reaction of more let-down once the ice is
removed. Breast binders are not effective in relieving the
discomforts of engorgement. Bromocriptine is no longer
recommended for lactation suppression.
A client is being discharged with nasal packing in place.
What should the nurse instruct the client to do?
Perform frequent mouth care.
Use normal saline nose drops daily.
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Sneeze and cough with mouth closed.
Gargle every 4 hours with salt water. - ANSWERFrequent
mouth care is important to provide comfort and encourage
eating. Mouth care promotes moist mucous membranes.
Nose drops cannot be used with nasal packing in place.
When sneezing and coughing, the client should do so with
the mouth open to decrease the chance of dislodging the
packing. Gargling should not be attempted with packing
in place.
A breastfeeding postpartum client experiencing breast
engorgement tells the nurse that she has applied cabbage
leaves to decrease her breast discomfort. What is the
nurse's best response?
"Using cabbage leaves to relieve engorgement is
considered a folk remedy."
"I'm concerned that the cabbage leaves may harm your
nursing baby."
"I need to notify your health care provider immediately
that you're using cabbage leaves."
"Let me know if you get relief using the cabbage leaves."
- ANSWER-Holistic nursing honors the client's
NCLEX-RN ACTUAL EXAM TEST
QUESTIONS & ANSWERS VERIFIED 100%
CORRECT
Which action should be included in the nursing care for a
client with cervical cancer who has an internal radium
implant in place?
Offer the bedpan every 2 hours.
Provide perineal care twice daily.
Check the position of the applicator hourly.
Offer a low-residue diet. - ANSWER-Bowel movements
can be difficult with the radium applicator in place. The
purpose of the low-residue diet is to decrease bowel
movements. The bowel is cleaned before therapy, and the
woman is maintained on a lowresidue diet during
treatment to prevent bowel distention and defecation. To
prevent dislodgment of the applicator, the client is
maintained on strict bed rest and allowed only to turn
from side to side. Perineal care is omitted during radium
implant therapy, although any vaginal discharge should be
,2 | Page
reported to the health care provider (HCP). It is rare for
the applicator to extrude, so this does not need to be
checked every hour.
A breastfeeding mother who is experiencing breast
engorgement asks the nurse if there is anything she can
do to get relief. What is the best intervention for the nurse
to implement? applying ice applying a breast binder
teaching how to express the breasts administering
bromocriptine - ANSWER-Teaching the client how to
express her breasts will facilitate let-down, and provide
temporary relief. Ice can promote comfort by decreasing
blood flow, numbing, and discouraging further let-down
of milk. It is not recommended because it also causes the
rebound reaction of more let-down once the ice is
removed. Breast binders are not effective in relieving the
discomforts of engorgement. Bromocriptine is no longer
recommended for lactation suppression.
A client is being discharged with nasal packing in place.
What should the nurse instruct the client to do?
Perform frequent mouth care.
Use normal saline nose drops daily.
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Sneeze and cough with mouth closed.
Gargle every 4 hours with salt water. - ANSWERFrequent
mouth care is important to provide comfort and encourage
eating. Mouth care promotes moist mucous membranes.
Nose drops cannot be used with nasal packing in place.
When sneezing and coughing, the client should do so with
the mouth open to decrease the chance of dislodging the
packing. Gargling should not be attempted with packing
in place.
A breastfeeding postpartum client experiencing breast
engorgement tells the nurse that she has applied cabbage
leaves to decrease her breast discomfort. What is the
nurse's best response?
"Using cabbage leaves to relieve engorgement is
considered a folk remedy."
"I'm concerned that the cabbage leaves may harm your
nursing baby."
"I need to notify your health care provider immediately
that you're using cabbage leaves."
"Let me know if you get relief using the cabbage leaves."
- ANSWER-Holistic nursing honors the client's
