NCLEX Questions, RN NCLEX Practice Test Questions, NCLEX-RN Questions, Nurselytic

Questions 158

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Extract:


Question 1 of 5

The nurse is preparing a 6-year-old child for an IV insertion. Which one of the following statements by the nurse is appropriate when preparing a child for a potentially painful procedure?

Correct Answer: A

Rationale: Educating the child about the pain may lessen anxiety. The child should be prepared for a potentially painful procedure but avoid suggesting pain. The nurse should allow the child his own sensory perception and evaluation of the procedure. The nurse should avoid absolute descriptive statements and allow the child his own perception of the procedure. The nurse should avoid evaluative statements or descriptions and give the child control in describing his reactions. False statements regarding a painful procedure will cause a loss of trust between the child and the nurse.

Question 2 of 5

A primigravida with diabetes is admitted to the labor and delivery unit at 34 weeks gestation. Which physician's order should the nurse question?

Correct Answer: B

Rationale: Terbutaline (Brethine) a tocolytic is used to stop preterm labor but is contraindicated in diabetic patients due to its risk of causing hyperglycemia. The other medications are appropriate for preeclampsia (magnesium sulfate) pain (butorphanol) or infection prophylaxis (cefazolin).

Question 3 of 5

A client with sickle cell disease is admitted in active labor. Which nursing intervention would be most helpful in preventing a sickling crisis?

Correct Answer: D

Rationale: IV fluids at 200 mL/hr prevent dehydration, a trigger for sickling crises, by maintaining hydration and blood flow. BP monitoring (
A), pain medication (
B), and ABGs (
C) are supportive but less directly preventive.

Question 4 of 5

A client with a history of atrial fibrillation is admitted with complaints of fatigue. The nurse should give priority to:

Correct Answer: A

Rationale: Fatigue in atrial fibrillation may indicate reduced cardiac output, so monitoring heart rate is the priority.

Question 5 of 5

The client is admitted with a diagnosis of gestational hypertension. Which assessment finding requires immediate notification of the physician?

Correct Answer: C

Rationale: Headache and visual disturbances in gestational hypertension suggest severe preeclampsia or impending eclampsia requiring immediate physician notification. BP of 140/90 proteinuria and edema are concerning but less urgent unless severe.

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