NCLEX-PN
NCLEX Trainer Test 8 Questions
Extract:
Question 1 of 5
The nurse is caring for a client with a chest tube. On the second postoperative day, the chest tube accidentally disconnects from the drainage tube. The first action the nurse should take is
Correct Answer: D
Rationale: Immediate steps should be taken to prevent air from entering the chest cavity. Lung collapse may occur if air enters the chest cavity. Clamping the tube close to the client's chest is the first action to take, followed by health care provider notification.
Question 2 of 5
Which instruction should be given to the client taking alendronate sodium (Fosamax)?
Correct Answer: C
Rationale: Alendronate sodium is a drug used to treat osteoporosis. The drug causes gastric reflux, so the client should remain upright for 30 minutes after taking it and take it with only water. Taking it before arising or with estrogen is incorrect, and forcing fluids is not necessary.
Question 3 of 5
A client treated for depression tells the nurse at the mental health clinic that he recently purchased a handgun because he is thinking about suicide. The first nursing action should be to
Correct Answer: A
Rationale: Notify the primary care provider immediately. The client’s suicidal intent and plan require immediate intervention by the healthcare team.
Extract:
A client develops severe, crushing chest pain radiating to the left shoulder and arm.
Question 4 of 5
Which of the following PRN medications should the nurse administer?
Correct Answer: C
Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) not an appropriate medication in this situation; antianxiety medication (2) Demerol is less commonly used because it may induce vomiting and initiate a vagal response (3) correct-morphine sulfate is given to reduce pain, anxiety, and cardiac workload; reduces the preload and afterload pressures (4) although a client at home may have taken NTG SL, the nurse would administer it IV to reduce pain and decrease overload
Extract:
Question 5 of 5
The nurse is caring for a client who had a transurethral resection of the prostate yesterday.
Correct Answer: A
Rationale: A urine output of 150 cc over 8 hours is critically low, indicating possible obstruction, bleeding, or renal impairment, requiring immediate intervention. Bladder spasms, bright red urine with clots, and burning are expected post-procedure but should be monitored.