3/21/25, 2:41 NCLEX-RN Flashcards |
PM
NCLEX-RN EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Terms in this set (21)
A client in a hospice program The desired outcome for management of pain is that the client's or family's
has increasing pain, and the subjective report of pain is acceptable and documented using a pain scale; the
nurse is goal is that
collaborating with the client to make a behavioral and physiologic indicators of pain are absent around the clock. The nurse
pain management plan. Which plan will be and client/family should develop a systematic approach to pain management using
most effective for the client? information gathered from history and a hierarchy of pain measurement. Pain
administering doses of analgesic when should be assessed at frequent intervals. The client should not wait to receive
pain is a "5" on a scale of 1 to 10. medication
providing enough analgesia to keep the until the pain is midpoint on the pain scale, nor should the client receive so much
client semi-somnolent pain medication that he or she is not alert. Continuous pain relief is the goal, not just
allowing an analgesia-free period so that during particular periods during the day.
the client can carry out daily hygienic
activities.
administering pain medications over a 24-
hour period
The nurse is instructing a client who has The client is instructed to chew food well to aid digestion and prevent
had an ileostomy about the diet following obstruction.The client should maintain an adequate fluid intake.The client is usually
surgery. The nurse should tell the placed on a regular diet but is encouraged to eat high-fiber, high-cellulose foods
client: "Limit your fluids to 1,000 (e.g., nuts, popcorn, corn, peas, tomatoes) with caution; these foods may swell in the
mL/day." intestine and cause an obstruction.Eating six small meals a day is not necessary.
"Chew your food thoroughly."
"There is no need to monitor your diet."
"Six small meals a day will prevent
abdominal distention."
1/
10
, 3/21/25, 2:41 NCLEX-RN Flashcards |
PM
A client with a history of posttraumatic The nurse should acknowledge that the client is performing self-care for anxiety
stress is panting and breathing heavily symptoms. The most respectful action is to allow privacy but to check on the client
while shouting out some strange words. frequently. The client is likely chanting or reciting a mantra. There is no indication that
The nurse reviews the nursing assessment the client is experiencing respiratory conflict. The client does not need a sitter or
and understands that the client is a psychiatric consult.
practicing a form of relaxation called
power
breathing. The best action for the nurse
to take is to:
monitor the client for respiratory
difficulties.
contact the health care provider for a
psychiatric consult.
allow privacy, but check on the client
frequently.
arrange for a sitter so the client is not left
alone.
Which action should be included in the Bowel movements can be difficult with the radium applicator in place. The purpose
nursing care for a client with of the low-residue diet is to decrease bowel movements. The bowel is cleaned
cervical before therapy, and the woman is maintained on a low-residue diet during
cancer who has an internal radium treatment to prevent bowel distention and defecation. To prevent dislodgment
implant in place? of the
Offer the bedpan every 2 hours. applicator, the client is maintained on strict bed rest and allowed only to turn from
Provide perineal care twice daily. side to side. Perineal care is omitted during radium implant therapy, although any
Check the position of the applicator hourly. vaginal discharge should be reported to the health care provider (HCP). It is rare for
Offer a low-residue diet. the applicator to extrude, so this does not need to be checked every hour.
A breastfeeding mother who is Teaching the client how to express her breasts will facilitate let-down, and
experiencing breast engorgement asks the provide temporary relief. Ice can promote comfort by decreasing blood flow,
nurse if there is anything she can do to get numbing, and discouraging further let-down of milk. It is not recommended because
relief. What is the best intervention for the it also causes the rebound reaction of more let-down once the ice is removed.
nurse to implement? Breast binders are not effective in relieving the discomforts of engorgement.
applying ice Bromocriptine is no
longer recommended for lactation suppression.
applying a breast binder
teaching how to express the breasts
administering bromocriptine
2/
10
PM
NCLEX-RN EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Terms in this set (21)
A client in a hospice program The desired outcome for management of pain is that the client's or family's
has increasing pain, and the subjective report of pain is acceptable and documented using a pain scale; the
nurse is goal is that
collaborating with the client to make a behavioral and physiologic indicators of pain are absent around the clock. The nurse
pain management plan. Which plan will be and client/family should develop a systematic approach to pain management using
most effective for the client? information gathered from history and a hierarchy of pain measurement. Pain
administering doses of analgesic when should be assessed at frequent intervals. The client should not wait to receive
pain is a "5" on a scale of 1 to 10. medication
providing enough analgesia to keep the until the pain is midpoint on the pain scale, nor should the client receive so much
client semi-somnolent pain medication that he or she is not alert. Continuous pain relief is the goal, not just
allowing an analgesia-free period so that during particular periods during the day.
the client can carry out daily hygienic
activities.
administering pain medications over a 24-
hour period
The nurse is instructing a client who has The client is instructed to chew food well to aid digestion and prevent
had an ileostomy about the diet following obstruction.The client should maintain an adequate fluid intake.The client is usually
surgery. The nurse should tell the placed on a regular diet but is encouraged to eat high-fiber, high-cellulose foods
client: "Limit your fluids to 1,000 (e.g., nuts, popcorn, corn, peas, tomatoes) with caution; these foods may swell in the
mL/day." intestine and cause an obstruction.Eating six small meals a day is not necessary.
"Chew your food thoroughly."
"There is no need to monitor your diet."
"Six small meals a day will prevent
abdominal distention."
1/
10
, 3/21/25, 2:41 NCLEX-RN Flashcards |
PM
A client with a history of posttraumatic The nurse should acknowledge that the client is performing self-care for anxiety
stress is panting and breathing heavily symptoms. The most respectful action is to allow privacy but to check on the client
while shouting out some strange words. frequently. The client is likely chanting or reciting a mantra. There is no indication that
The nurse reviews the nursing assessment the client is experiencing respiratory conflict. The client does not need a sitter or
and understands that the client is a psychiatric consult.
practicing a form of relaxation called
power
breathing. The best action for the nurse
to take is to:
monitor the client for respiratory
difficulties.
contact the health care provider for a
psychiatric consult.
allow privacy, but check on the client
frequently.
arrange for a sitter so the client is not left
alone.
Which action should be included in the Bowel movements can be difficult with the radium applicator in place. The purpose
nursing care for a client with of the low-residue diet is to decrease bowel movements. The bowel is cleaned
cervical before therapy, and the woman is maintained on a low-residue diet during
cancer who has an internal radium treatment to prevent bowel distention and defecation. To prevent dislodgment
implant in place? of the
Offer the bedpan every 2 hours. applicator, the client is maintained on strict bed rest and allowed only to turn from
Provide perineal care twice daily. side to side. Perineal care is omitted during radium implant therapy, although any
Check the position of the applicator hourly. vaginal discharge should be reported to the health care provider (HCP). It is rare for
Offer a low-residue diet. the applicator to extrude, so this does not need to be checked every hour.
A breastfeeding mother who is Teaching the client how to express her breasts will facilitate let-down, and
experiencing breast engorgement asks the provide temporary relief. Ice can promote comfort by decreasing blood flow,
nurse if there is anything she can do to get numbing, and discouraging further let-down of milk. It is not recommended because
relief. What is the best intervention for the it also causes the rebound reaction of more let-down once the ice is removed.
nurse to implement? Breast binders are not effective in relieving the discomforts of engorgement.
applying ice Bromocriptine is no
longer recommended for lactation suppression.
applying a breast binder
teaching how to express the breasts
administering bromocriptine
2/
10
