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Questions 164

NCLEX-PN

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Extract:


Question 1 of 5

The nurse makes a home visit to a client with Alzheimer disease. While reviewing the client's home care needs, the client's spouse states, 'It's hard to see my spouse worsen each day. I'm not sure I can keep doing this alone anymore.' Which response by the nurse is best?

Correct Answer: B

Rationale: Exploring the spouse's daily challenges encourages open communication and helps identify specific support needs.

Question 2 of 5

A 2 month-old child has had a cleft lip repair. The selection of which restraint would require no further action by the charge nurse?

Correct Answer: A

Rationale: Elbow. The elbow restraint will prevent the child from touching the surgical site without hindering movement of other parts of the body.

Question 3 of 5

A behavior modification program is planned for an adolescent who exhibits disruptive behavior. Which action by the nurse is most consistent with a behavior modification program?

Correct Answer: B

Rationale: Positive reinforcement (extra privileges for non-disruptive behavior) aligns with behavior modification, encouraging desired actions. Punishment, reminders, or asking perceptions are less effective.

Question 4 of 5

The nurse is observing the movements of a client receiving Thorazine (chlorpromazine). The client continually paces and rocks back and forth when sitting. The nurse recognizes that the client is experiencing:

Correct Answer: B

Rationale: Akathisia is characterized by restlessness, pacing, and rocking, which matches the client's symptoms. Answer A involves fixed upward gaze, Answer C involves muscle spasms, and Answer D involves slowed movements, all of which are incorrect.

Question 5 of 5

The nurse is caring for a client with detoxification from alcohol. Which medication is used in the treatment of alcohol withdrawal?

Correct Answer: D

Rationale: Ativan (lorazepam), a benzodiazepine, is used to manage alcohol withdrawal symptoms like seizures and agitation. Antabuse deters drinking, flumazenil reverses benzodiazepines, and methadone treats opioid withdrawal.

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