Questions 150

NCLEX-RN

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Question 1 of 5

You are working in a community pediatric health clinic. Which expected life transition should you apply into your practice for these pediatric clients as you are caring for pediatric clients of all ages?

Correct Answer: B

Rationale: Puberty is a significant life transition for pediatric clients, particularly adolescents, and is relevant across the age range in a pediatric clinic. It involves physical, emotional, and social changes that nurses should consider in their practice.

Question 2 of 5

A client has received electroconvulsive therapy (ECT). What intervention should the nurse perform first in the posttreatment area and upon the client's awakening?

Correct Answer: B

Rationale: The nurse should first monitor vital signs, orient the client, and review with the client that he or she just received an ECT treatment. The posttreatment area should include accessibility to the anesthesia staff, oxygen, suction, pulse oximeter, vital sign monitoring, and emergency equipment. The nursing interventions outlined in the remaining options will follow accordingly.

Question 3 of 5

A family member asks to take the client, who is on aneurysm precautions, to the unit lounge for 'just a few minutes.' Which concepts should the nurse use when explaining why the client must remain in the room?

Correct Answer: C

Rationale: Subarachnoid precautions (or aneurysm precautions) are intended to minimize environmental stimuli, which could increase intracranial pressure and trigger bleeding or rupture of the aneurysm. The aneurysm will not heal more rapidly with reduced stimuli. The client does not need isolation to 'cope' with photosensitivity (although photosensitivity may be a problem). No data indicate that the client has disorganization of thoughts and feelings.

Question 4 of 5

A client with a history of migraine headaches is prescribed sumatriptan (Imitrex). The nurse should instruct the client to:

Correct Answer: A

Rationale: Sumatriptan is most effective when taken at the onset of a migraine to abort the attack.

Question 5 of 5

A client tells the nurse that he is going to harm his brother-in-law, who called the police on him for threatening to hurt his ex-wife. The nurse should notify which of the following persons? Select all that apply.

Correct Answer: C,D

Rationale: The nurse has a duty to warn the intended victim (brother-in-law) and notify the police due to the credible threat of harm. Notifying administrators or social services may be secondary, and the ex-wife is not the current target.

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