NCLEX-PN
Free NCLEX-PN Practice Questions Questions
Extract:
Question 1 of 5
A client is receiving nitroglycerin ointment (Nitrol) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?
Correct Answer: C
Rationale: Hypotension and headache are the most common adverse effects of nitroglycerin.
Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration.
Question 2 of 5
A client with a peptic ulcer had a partial gastrectomy and vagotomy (Billroth I). In planning the discharge teaching, the client should be cautioned by the nurse about which of the following?
Correct Answer: D
Rationale:
To prevent dumping syndrome post-gastrectomy, clients should avoid large meals high in simple sugars and liquids, which can cause rapid gastric emptying. Clients should recline for 30 minutes after eating (not sit up,
A), drink fluids between meals (not avoid,
B), and reduce carbohydrate intake (not increase,
C).
Extract:
A patient regains consciousness and has expressive aphasia.
Question 3 of 5
As a part of the long-range planning, the nurse should:
Correct Answer: A
Rationale: Positive feedback encourages progress in expressive aphasia recovery.
Extract:
Question 4 of 5
Following a classic cholecystectomy resection for multiple stones, the PACU nurse observes a serosanguinous drainage on the dressing. The most appropriate intervention is to:
Correct Answer: C
Rationale: Serosanguinous drainage is normal post-cholecystectomy; reinforcing the dressing is appropriate to manage it. Changing the dressing risks infection, and a binder may obscure assessment. Basic Care and Comfort
Extract:
Pulsus Paradoxus is best described as
Question 5 of 5
Pulsus Paradoxus is best described as
Correct Answer: B
Rationale: Pulsus paradoxus is an exaggerated drop in systolic BP during inspiration.