NCLEX-PN
Kaplan NCLEX Question of The Day Questions
Question 1 of 5
The nurse is caring for a client with full-thickness burns to the left arm and trunk. What is the priority for this client?
Correct Answer: C
Rationale: Correct! With full-thickness burns, there is a significant risk of fluid loss through the burn wound and fluid shift, leading to hypovolemia and shock. Monitoring and maintaining the client's fluid volume status is crucial to prevent complications like hypovolemic shock. Pain management (Option
A) is essential but not the priority in this situation. While airway assessment (Option
B) is crucial, it is typically assessed first in clients with respiratory distress. Preventing infection (Option
D) is important but managing fluid volume status takes precedence in the initial care of a client with full-thickness burns.
Question 2 of 5
What is most important for the healthcare professional to do prior to initiating peritoneal dialysis?
Correct Answer: D
Rationale: The correct answer is to warm the fluids. Warming the dialysis fluids is crucial before initiating peritoneal dialysis to prevent abdominal discomfort and promote vasodilation, which helps in achieving good exchange in the peritoneum. Aspirating to check placement (
Choice
A) is not typically necessary before initiating peritoneal dialysis. Ensuring the client voids (
Choice
B) is not directly related to the procedure of peritoneal dialysis. Irrigating the catheter to maintain patency (
Choice
C) is usually done as part of routine care but is not specifically required prior to initiating peritoneal dialysis.
Therefore, the most important action to take before starting peritoneal dialysis is to warm the fluids.
Question 3 of 5
When dressing a severe burn to the right hand, it is important for the nurse to:
Correct Answer: B
Rationale: When dressing a severe burn to the hand, it is crucial to wrap each digit individually to prevent webbing, which can lead to contractures and impaired function. Applying a wet-to-dry dressing for debridement is not recommended for burn wounds as it can cause trauma to the wound bed during removal. Opening blisters can increase the risk of infection and delay healing. Allowing the client to perform the dressing change may not ensure proper care and can lead to complications.
Question 4 of 5
A 13-year-old girl is admitted to the ER with lower right abdominal discomfort. What should the admitting nurse do first?
Correct Answer: D
Rationale: In a case of lower right abdominal discomfort, the first step should be to provide pain reduction techniques without administering medication. Administering pain medication or starting a central line should not be done without medical orders. Placing the patient in a right sidelying position may help with pressure relief, but addressing pain reduction techniques without medication is the initial priority in this scenario. It is essential to assess the patient further, consult with a healthcare provider, and follow the appropriate protocols before administering any medication or invasive procedures like starting a central line.
Question 5 of 5
The client is taking Antabuse and should avoid eating foods that may trigger a disulfiram reaction. The nurse should instruct the client to avoid:
Correct Answer: C
Rationale: The client taking Antabuse should avoid foods that contain alcohol or vinegar as they can trigger a disulfiram reaction. Pickles and vinaigrette dressing often contain vinegar, which the client should avoid. Beef is safe to consume.
Choices A, B, and D do not contain alcohol or vinegar, so they are allowed for the client taking Antabuse.