NCLEX-PN
NCLEX Trainer Test 2 Questions
Extract:
Question 1 of 5
A depressed client who has recently been acting suicidal is now more social and energetic than usual. Smilingly he tells the nurse 'I've made some decisions about my life.' What should be the nurse's initial response?
Correct Answer: B
Rationale: Are you thinking about killing yourself? This validates suicidal ideation to assess the seriousness of the risk.
Question 2 of 5
The nurse is caring for a client with a history of heart failure who is receiving metoprolol (Lopressor) 50 mg PO bid. Which of the following findings would be of GREATest concern to the nurse?
Correct Answer: A
Rationale: A heart rate of 50 bpm indicates bradycardia, a serious side effect of metoprolol, a beta-blocker, requiring immediate evaluation to prevent reduced cardiac output. Options B, C, and D are normal: blood pressure 130/80 mmHg, respiratory rate 18 breaths/min, and oxygen saturation 95% are stable.
Extract:
A client is going to be taking imipramine (Tofranil) at home following discharge.
Question 3 of 5
The nurse should instruct the client to report which of the following immediately to the nurse?
Correct Answer: A
Rationale: Strategy: Think about each answer choice. (1) correct-possible side effects of
Tofranil, a tricyclic antidepressant medication, which can be resolved by altering the dosage or changing the medication (2) describes side effects of antidepressants, which client can learn to manage at home without changing the medication (3) describes side effects of a different category of medications (4) describes side effects of a different category of medications
Extract:
Question 4 of 5
The nurse is caring for a client who is receiving IV vancomycin for a methicillin-resistant Staphylococcus aureus (MRSA) infection. Which of the following findings would be of GREATest concern to the nurse?
Correct Answer: C
Rationale: Redness at the IV site suggests phlebitis or infiltration, which can lead to tissue damage or reduced vancomycin delivery, requiring immediate action. Options A, B, and D are normal: blood pressure 130/80 mmHg, heart rate 88 bpm, and urine output 50 mL/hour indicate stability.
Question 5 of 5
The nurse is working on a plan to assist an abused client back into the work situation. Which will likely be most helpful in decreasing the trauma for the client?
Correct Answer: A
Rationale: Support from significant others provides emotional stability, most effective in reducing trauma for an abused client re-entering work.