NCLEX-RN
Health Promotion NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
A client being discharged to home after angioplasty via the right femoral groin has received the catheter insertion site discharge instructions from the nurse. Which client statement indicates that the client understands the instructions?
Correct Answer: D
Rationale: The client may feel some mild discomfort at the catheter insertion site after angioplasty. This is usually relieved by analgesics such as acetaminophen (Tylenol). The client is taught to report to the primary health care provider any neurovascular changes to the affected leg; bleeding or bruising at the insertion site; and signs/symptoms of local infection, such as drainage at the site or increased temperature.
Question 2 of 5
The nurse is performing an assessment on a primigravida client who has been a marathon runner for several years. The client verbalizes concern because she is no longer able to run in marathons and is concerned about the brown discoloration on her face and her increasing size. Which statements by the nurse are therapeutic?
Correct Answer: A,B
Rationale: The client is concerned about the body changes and life changes being experienced as a result of pregnancy. Therapeutic communication techniques include focusing on the client's feelings and concerns and acknowledging these concerns by the techniques of clarifying and encouraging discussion of feelings. Telling a client 'not to worry,' placing the client's feelings on hold, and avoiding discussion of the client's feelings are nontherapeutic communication techniques.
Question 3 of 5
The nurse provides information to a client who is scheduled for the implantation of an implantable cardioverter defibrillator (ICD) regarding care after implantation. The nurse tells the client that there is a need to keep a diary. What information should the nurse provide concerning the primary purpose of the diary?
Correct Answer: D
Rationale: The primary purpose of the ICD diary is to record comprehensive data (date, time, activity, symptoms, number of shocks, and post-shock feelings) for the provider to adjust medical management, particularly medication therapy. Other options are specific aspects of this broader purpose.
Question 4 of 5
The nurse provides discharge instructions to the mother of a child who was hospitalized for heart surgery. Which instruction should the nurse provide to the mother?
Correct Answer: D
Rationale: Notifying the primary health care provider if the child develops a fever greater than 100.5°F (38°
C) is critical to detect potential infections post-heart surgery. The child should not play outside for several weeks to avoid infection or injury. No creams, lotions, or powders should be applied to the incision until fully healed. The child should not return to school until 3 weeks after discharge, starting with half days.
Question 5 of 5
A client who sustained a thoracic cord injury a year ago returns to the clinic for a follow-up visit, and the nurse notes a small reddened area on the coccyx. The client is not aware of the reddened area. After counseling the client to relieve pressure on the area by adhering to a turning schedule, which action by the nurse is most appropriate?
Correct Answer: C
Rationale: The client should be encouraged to be as independent as possible. The most effective means of skin self-assessment for this client is with the use of a mirror. The redness cannot be felt. Asking a family member to assess the skin daily does not promote independence. It is unnecessary and unrealistic for the client to return to the clinic daily for a skin check.