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Questions 227

NCLEX-PN

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Extract:

The mother's condition has deteriorated during labor and a cesarean section is required. Her husband is worried and anxious about the changed of plan and demand for an explanation.


Question 1 of 5

Who among the following should explain the procedure to the husband?

Correct Answer: A

Rationale: The surgeon, as the procedure performer, is best suited to explain the cesarean section.

Extract:


Question 2 of 5

The nurse is performing an assessment of the motor function in a client with a head injury. The best technique is

Correct Answer: D

Rationale: rubbing the sternum. The purpose is to assess the non-responsive client's reaction to a painful stimulus after less noxious methods have been tried.

Question 3 of 5

The nurse is caring for an adult who has ulcerative colitis. When planning care, the nurse knows that which nursing diagnosis is of highest priority?

Correct Answer: A

Rationale: Ulcerative colitis causes diarrhea, leading to fluid loss and dehydration, making deficient fluid volume the highest priority to prevent systemic complications like hypovolemia.

Question 4 of 5

A client with retinal detachment of the right eye has a scleral buckling with instillation of silicone oil. Post-operatively the client should be positioned:

Correct Answer: D

Rationale: Following a scleral buckling with instillation of silicone oil or gas, the client should be positioned prone with the head turned so that the operative eye is facing upward. Answers A, B, and C would displace the oil and prevent it from enhancing a seal between the retina and choroid.

Question 5 of 5

The nurse is preparing to discharge a client who is receiving Nardil (phenelzine). The nurse should tell the client to:

Correct Answer: B

Rationale: Drug interactions between an MAOI and pseudoephedrine can result in hypertensive crisis. Answer A refers to the client receiving antipsychotic medications such as Thorazine, so it is incorrect. Answers C and D do not apply to MAOIs, so they are incorrect.

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