EVALUATED QUESTIONS FOR NCLEX PN

EVALUATED QUESTIONS FOR NCLEX PN The nurse is administering sublingual nitroglycerin to a client. Immediately afterward, the client may experience: - CORRECT ANSWER-throbbing headache or dizziness. A client with iron deficiency anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of this type of anemia? - CORRECT ANSWER-Dyspnea, tachycardia, and pallor The nurse is caring for a client taking an anticoagulant. Which instruction regarding anticoagulant therapy should the nurse give the client? - CORRECT ANSWER-Limit foods high in vitamin K. The nurse delivers a client's 10 a.m. medications. The client is away from his room for a diagnostic study. Which action is most appropriate for the nurse to take? - CORRECT ANSWER-Lock the medications in the medicine preparation area until the client returns. The nurse is caring for a client receiving patient-controlled analgesia (PCA) for pain management. Which statement about PCA is true? - CORRECT ANSWER-Pain relief is initiated by the client as needed. The nurse is caring for a client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: - CORRECT ANSWER-15 to 20 g of a fast-acting carbohydrate such as orange juice. The nurse is caring for an elderly female with osteoporosis. When teaching the client, the nurse should include information about which major complication? - CORRECT ANSWER-Bone fracture The nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women: - CORRECT ANSWER-have a mammogram annually. The nurse is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination: - CORRECT ANSWERimmediately after her menses. The nurse is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover: - CORRECT ANSWER-changes from previous self-examinations. The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should the nurse recommend? - CORRECT ANSWER-Flexible sigmoidoscopy beginning at age 50 Which nursing diagnosis should the nurse expect to see in a care plan for a client in sickle cell crisis? - CORRECT ANSWER-Acute pain related to sickle cell crisis What can the nurse do to prevent lipodystrophy when administering insulin to a diabetic client? - CORRECT ANSWER-Rotate the injection sites. For a diabetic client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and at bedtime. Why are the wet-to-dry dressings used for this client? - CORRECT ANSWERBecause they debride the wound and promote healing by secondary intention. An obese client is admitted to the hospital for abusing amphetamines in an attempt to lose weight. Which nursing intervention is appropriate for this client? - CORRECT ANSWER-Identify alternative ways for the client to lose weight. Policy and procedure dictate that hand washing is a requirement when caring for clients. Which statement about hand washing is true? - CORRECT ANSWER-Frequent hand washing reduces transmission of pathogens from one client to another. The nurse is evaluating a postoperative client for infection. Which sign or symptom would be most indicative of infection? - CORRECT ANSWER-Red, warm, tender incision The nurse is caring for a client with a fractured hip. The client is combative, confused, and trying to get out of bed. The nurse should: - CORRECT ANSWER-obtain a physician's order to restrain the client when less restrictive interventions fail. The nurse is caring for a bedridden, elderly adult. To prevent pressure ulcers, which intervention should the nurse include in the care plan? - CORRECT ANSWER-Post a turning schedule at the client's bedside. A client who has recently had surgery for prostate cancer expresses to the nurse feelings of anger toward God, his church, and the clergy. Which intervention is appropriate for this client? - CORRECT ANSWER-Encouraging the client to discuss concerns with the clergy The nurse is working in a support group for clients with acquired immunodeficiency syndrome (AIDS). Which point about preventing transmission of the human immunodeficiency virus (HIV) is most important for the nurse to stress? - CORRECT ANSWER-Following safer-sex practices The nurse is preparing to begin one-person cardiopulmonary resuscitation. The nurse should first: - CORRECT ANSWER-establish unresponsiveness. The nurse is providing home care instructions to a client who has recently had a skin graft. It's most important that the client remember to: - CORRECT ANSWER-protect the graft from direct sunlight. The nurse is caring for a client who underwent a subtotal gastrectomy 24 hours earlier. The client has a nasogastric (NG) tube. The nurse should: - CORRECT ANSWERirrigate the NG tube gently with normal saline solution as prescribed. A client is to be discharged from an acute care facility following treatment for right leg thrombophlebitis. The nurse notes that the client's leg is pain-free, without redness or edema. The nurse's actions reflect which step of the nursing process? - CORRECT ANSWER-Evaluation The nurse is caring for a client who recently underwent a total hip replacement. The nurse should: - CORRECT ANSWER-limit client hip flexion while sitting. When caring for a client who's being treated for hyperthyroidism, it's important to: - CORRECT ANSWER-balance the client's periods of activity and rest. Which intervention should the nurse try first with a client who exhibits signs of sleep disturbance? - CORRECT ANSWER-Provide the client with sleep aids, such as pillows, back rubs, and snacks. When preparing a client for an enema, the nurse should help him into the: - CORRECT ANSWER-left-lateral Sims' position. The nurse is caring for a client with a right ankle sprain. When applying cold to the client's injury, the nurse should: - CORRECT ANSWER-apply it immediately after the injury occurs. The nurse is teaching a client with a family history of atherosclerosis. To decrease the risk of atherosclerosis, the nurse should encourage the client to: - CORRECT ANSWER-increase his activity level.