NCLEX-PN
Nclex Exam Cram Practice Questions Questions
Extract:
Question 1 of 5
A client with which of the following conditions is at risk for developing a high ammonia level?
Correct Answer: D
Rationale: Cirrhosis is the correct answer. In cirrhosis, the liver is unable to detoxify ammonia to urea, leading to an accumulation of ammonia in the blood. This can result in hepatic encephalopathy, a condition characterized by high ammonia levels affecting brain function. Renal failure (
Choice
A), psoriasis (
Choice
B), and lupus (
Choice
C) are not directly associated with an increased risk of high ammonia levels as seen in cirrhosis.
Question 2 of 5
What should be included in the assessment of a client with a cast?
Correct Answer: A
Rationale: When assessing a client with a cast, it is crucial to check for capillary refill to ensure adequate circulation. Warm toes indicate good circulation, while the absence of discomfort suggests the cast is not causing any pain or undue pressure on the client.
Therefore, choices B, C, and D are incorrect as they do not address the essential components of assessing a client with a cast.
Question 3 of 5
The nurse and a colleague are on the elevator after their shift, and they hear a group of healthcare providers discussing a recent client scenario. Which client right might be breached?
Correct Answer: C
Rationale: The right to confidentiality of client information might be breached when client care situations are discussed in public areas or without regard to maintaining the information as private and confidential. In this scenario, the conversation on the elevator could lead to a breach of the client's right to confidentiality. The other options, such as the right to refuse treatment, right to continuity of care, and right to reasonable responses to requests, are not being breached in this instance, making them incorrect choices.
Question 4 of 5
The nurse is preparing to administer IV Vancomycin to a client. Which of the following nursing actions should be taken first?
Correct Answer: D
Rationale: Before administering any medication, including IV Vancomycin, it is crucial to ensure that the client is not allergic to the medication. This is the most critical action to prevent any potential allergic reactions. While performing a physical assessment is important, it may not be as time-sensitive as checking for allergies. Obtaining lab values related to renal function is also significant with Vancomycin due to its potential nephrotoxicity, but ensuring the client's safety by checking for allergies takes precedence. Reviewing peaks and troughs is important for monitoring drug levels, but it is a secondary step compared to checking for allergies prior to administration.
Question 5 of 5
Major competencies for the nurse giving end-of-life care include:
Correct Answer: A
Rationale: In providing end-of-life care, nurses must possess essential competencies. Demonstrating respect and compassion, along with applying knowledge and skills in caring for both the family and the client, are crucial competencies. These skills help create a supportive and empathetic environment for individuals facing end-of-life situations.
Choice B is incorrect because while assessing and intervening are important, they do not encompass the core competencies required for end-of-life care.
Choice C is also incorrect; although setting goals and expectations is valuable, the primary focus should be on providing compassionate care.
Choice D is incorrect as withholding sad news goes against the principles of honesty and transparency in end-of-life care.