NCLEX-PN
NCLEX Trainer Test 2 Questions
Extract:
Question 1 of 5
A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropesol) 0.4 mg, and promethazine hydrochloride (Phenergan) 50 mg IM to a pre-operative client. Which action should the nurse take first?
Correct Answer: D
Rationale: Have the client empty bladder. The first step in the process is to have the client void prior to administering the pre-operative medication. The other actions follow this initial step in this sequence: D, C, B, A.
Note: It is much easier to administer IM meds with the side rails down, and then raising them when the nurse is done. Other activities can then be carried out more safely.
Question 2 of 5
A diabetic client has been maintained on Glucophage (metformin) for regulation of his blood glucose levels. Which teaching should be included in the plan of care?
Correct Answer: A
Rationale: Metformin can affect kidney function, so changes in urinary patterns should be reported. Optimal effects occur sooner than six weeks , carbohydrates should be balanced, not increased , and itching is not a common side effect .
Question 3 of 5
An adult male calls his nurse neighbor and says he is having severe chest pain and feels as though something terrible is happening to him. He rates his pain as 10 on the 10-point scale. In addition to calling 911, what should the nurse recommend the man do now?
Correct Answer: A
Rationale: Aspirin reduces clot formation in suspected myocardial infarction, improving outcomes, and should be taken immediately.
Question 4 of 5
A woman calls the physician's office stating that her 16-year-old daughter took 20 or 30 sleeping pills. The mother tells the nurse that her daughter is awake and says, 'Leave me alone. I just want to die.' How should the nurse respond?
Correct Answer: D
Rationale: A suicide attempt with sleeping pills requires immediate emergency care to prevent overdose complications. Other responses delay critical intervention.
Extract:
A client is diagnosed with lung cancer and undergoes a pneumonectomy.
Question 5 of 5
In the immediate postoperative period, which of the following nursing assessments is MOST important?
Correct Answer: B
Rationale: Strategy: Determine how each answer choice relates to a pneumonectomy. (1) on the surgical side, breath sounds will be absent (2) correct-position of the trachea should be evaluated; with a tracheal shift, an increase in pressure could occur on the operative side and could cause pressure against the mediastinal area (3) important to observe but not as high a priority (4) does not relate to the situation