NCLEX-PN
NCLEX Trainer Test 3 Questions
Extract:
Question 1 of 5
A client has a repair of a hiatal hernia using a thoracic approach. During the immediate post-op period, the nurse should carefully assess the client for:
Correct Answer: B
Rationale: A thoracic approach affects the chest, so respiratory changes (e.g., distress, decreased oxygen saturation) are critical to assess post-op. Appetite, anxiety, and activity intolerance are less immediate concerns.
Extract:
A client is scheduled for a cardiac catheterization at 8 AM. The client's laboratory work was completed five days ago. The results were: K⺠3.0 mEq/L, Na⺠148 mEq/L, glucose 178 mg/dL. He complains of muscle weakness and cramps.
Question 2 of 5
Which of the following nursing actions is BEST?
Correct Answer: C
Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) Aldactone is potassium-sparing diuretic and is an oral medication, patient is NPO for procedure (2) is not feasible prior to the cardiac cath because the client is NPO (3) correct-signs and symptoms are indicative of hypokalemia; stat serum K⺠level is needed to confirm the K⺠level prior to going for cardiac catheterization (4) is unnecessary at this time
Extract:
Question 3 of 5
The client is scheduled for a myelogram today. The permit has been signed. The client tells the nurse that she has changed her mind and does not want to have the procedure. What should the nurse do?
Correct Answer: D
Rationale: Clients have the right to withdraw consent at any time, respecting autonomy. Coercion or suggesting physician displeasure is unethical.
Question 4 of 5
The nurse is to administer the daily dose of digoxin to an adult client. What is it essential for the nurse to do before administering the medication?
Correct Answer: D
Rationale: Digoxin slows heart rate; checking the apical pulse ensures it's above 60 bpm to avoid bradycardia. Temperature, blood pressure, and respirations are less critical.
Extract:
During the second session of individual therapy, a client sits quietly with arms folded and eyes cast down.
Question 5 of 5
Which of the following statements by the nurse is BEST?
Correct Answer: D
Rationale: Strategy: 'BEST' indicates that this is a priority question. Remember therapeutic communication. (1) is used to get client comfortable, but would not help to focus on what is important (2) focusing on client's difficulty speaking may make him defensive and block communication (3) concrete questions will encourage client to give yes/no answers, factual answers may block communication of feelings (4) correct-reflection allows client to verbalize feelings