NCLEX-PN
Free NCLEX-PN Practice Questions Questions
Extract:
You're able to elicit a Babinski's response in your 9-month-old patient.
Question 1 of 5
This is
Correct Answer: A
Rationale: A positive Babinski's response is normal in infants up to 12–24 months due to immature corticospinal tracts.
Extract:
After the patient has refused the medication, the next step taken by the nurse will be:
Question 2 of 5
Document the patient's refusal.
Correct Answer: B
Rationale: Exploring the reason for refusal helps address concerns and promote adherence.
Extract:
Question 3 of 5
A client is receiving nitroglycerin ointment (Nitrol) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?
Correct Answer: C
Rationale: Hypotension and headache are the most common adverse effects of nitroglycerin.
Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration.
Question 4 of 5
A nurse is caring for a patient who is receiving chemotherapy. Which of the following medications should the nurse anticipate administering to prevent nausea and vomiting?
Correct Answer: A
Rationale: Ondansetron, a 5-HT3 antagonist, is the first-line antiemetic for chemotherapy-induced nausea, effectively blocking serotonin receptors. Other medications are less specific or used adjunctively.
Question 5 of 5
A client refuses to take the medication prescribed because the client prefers to take self-prescribed herbal preparations. What is the initial action the nurse should take?
Correct Answer: B
Rationale: Respect for differences is demonstrated by incorporating traditional cultural practices for staying healthy into professional prescriptions and interventions. The challenge for the health care provider is to understand the client's perspective. 'Culture care preservation or maintenance refers to those assistive, supporting, facilitative or enabling professional actions and decisions that help people of a particular culture to retain and/or preserve relevant care values to that they can maintain their well-being, recover from illness or face handicaps and/or death.'