NCLEX-RN
NCLEX RN Test Bank Questions PDF Questions
Extract:
Question 1 of 5
A nurse is caring for a woman who delivered a term neonate at 6 a.m. At 4 p.m., the woman has a distended bladder and is reporting pain of 5 on a scale of 1 to 10. The nurse reviews the client's output record. What should the nurse do first?
Correct Answer: D
Rationale: A distended bladder causing pain requires immediate relief via catheterization to prevent complications like urinary retention or bladder injury.
Question 2 of 5
A medication nurse is supervising a newly hired nurse who is administering pyridostigmine orally to a client diagnosed with myasthenia gravis. Which instruction provided to the client indicates safe practice by the newly hired nurse regarding the administration of this medication?
Correct Answer: A
Rationale: Myasthenia gravis can affect the client's ability to swallow. The primary assessment is to determine the client's ability to swallow. In this situation, there is no reason for the client to lie down to swallow medication or hyperextend the neck. Additionally, lying down could place the client at risk for aspiration. There is no specific reason for the client to void before taking the medication.
Question 3 of 5
A client with a history of peptic ulcer disease is prescribed lansoprazole (Prevacid). The nurse should instruct the client to:
Correct Answer: A
Rationale: Lansoprazole is most effective when taken before meals to reduce acid production.
Question 4 of 5
A client with a history of bipolar disorder is prescribed lithium. The nurse should instruct the client to:
Correct Answer: A
Rationale: Consistent sodium intake prevents lithium toxicity, as sodium fluctuations affect lithium levels.
Question 5 of 5
When a client with alcohol dependency begins to talk about not having a problem with alcohol, the nurse should use which of the following approaches?
Correct Answer: D
Rationale: This approach uses therapeutic communication, acknowledging the client's perspective and encouraging problem-solving, which is effective for addressing denial in alcohol dependency.