NCLEX Questions, NCLEX-PN Free Practice Questions Questions, NCLEX-PN Questions, Nurselytic

Questions 227

NCLEX-PN

NCLEX-PN Test Bank

NCLEX-PN Free Practice Questions Questions

Extract:

Following major abdominal surgery, Mrs. Lafayette, was started on Morphine infusion via PCA (patient's controlled analgesia) pump.


Question 1 of 5

Priority nursing care for the patient would include:

Correct Answer: A

Rationale: Morphine sulfate is a central nervous system depressant, and respiratory depression is a serious side effect, making respiratory status the priority.

Extract:


Question 2 of 5

The nurse is assigned to a client with a radical mastectomy. Which intervention by the nurse demonstrates the concept of caring?

Correct Answer: C

Rationale: Arranging a Reach for Recovery visit offers peer support, addressing emotional and psychological needs, demonstrating caring. Other options are educational but less focused on emotional support.

Question 3 of 5

One aspect of implementation related to drug therapy is:

Correct Answer: B

Rationale: Although documentation isn't a step in the nursing process, the nurse is legally required to document activities related to drug therapy, including the time of administration, the quantity, and the client's reaction. Developing a content outline, establishing outcome criteria, and setting realistic client goals are parts of planning rather than implementation.

Question 4 of 5

A client with a history of seizures is prescribed phenytoin (Dilantin) 100 mg tid. The nurse should instruct the client to

Correct Answer: B

Rationale: Alcohol can lower phenytoin levels, increasing seizure risk, so avoidance is critical. Taking with meals (
A) is unnecessary, calcium (
C) is unrelated, and stopping for a rash (
D) requires physician consultation due to potential Stevens-Johnson syndrome.

Question 5 of 5

The nurse is caring for an 11-year-old patient being treated for a fractured right femur with balanced suspension traction with a Thomas splint and Pearson attachment. The nurse notes that the patient's left leg is externally rotated. The nurse should

Correct Answer: A

Rationale: A trochanter roll placed on the outer aspect of the thigh holds the hip in a neutral position and prevents external rotation, maintaining proper leg alignment. Resistive exercises or active movement (choices B and
C) do not address alignment, and instructing the patient (choice
D) is ineffective without physical support.

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