NCLEX-RN
Health Care of the Older Adult NCLEX Questions
Extract:
Question 1 of 5
A small airplane crashes in a neighborhood of 10 houses. One of the victims appears to have a cervical spine injury. What should first-aid for this victim should be selected that apply.
Correct Answer: A,B,E
Rationale: For a suspected cervical spine injury, the airway should be opened with the jaw-thrust maneuver, the spine immobilized, and a cervical collar applied to prevent further injury. Logrolling or elevating feet could exacerbate the injury.
Question 2 of 5
Which assessment is critical for a client receiving thrombolytic therapy?
Correct Answer: B
Rationale: Blood pressure is critical to monitor during thrombolytic therapy to prevent hemorrhagic complications.
Question 3 of 5
The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack?
Correct Answer: B
Rationale: Viral respiratory infections are a leading trigger of acute asthma attacks due to airway inflammation.
Toxins, smoke, and cold exercise are also triggers but less common.
Question 4 of 5
The client with a cataract tells the nurse that she is afraid of being awake during eye surgery. Which of the following responses by the nurse would be the most appropriate?
Correct Answer: B
Rationale: The nurse should give a client who seems fearful of surgery an opportunity to express her feelings. Only after identifying the client's concerns can the nurse address them appropriately. Asking about previous reactions to anesthetics or discussing nausea does not address the client's fear. Minimizing the client's feelings by saying there is nothing to fear ignores her concerns.
Question 5 of 5
An overweight client taking warfarin (Coumadin) has a nursing diagnosis of ineffective tissue perfusion related to decreased arterial blood flow. What should the nurse instruct the client to do? Select all that apply.
Correct Answer: B,C,E
Rationale: Rationales:
B) A reduced-calorie, reduced-fat diet helps manage weight and reduce atherosclerosis progression, improving arterial blood flow.
C) Daily inspection for ulcerations is essential in PVD to detect early skin breakdown due to poor perfusion. E) Using an electric razor minimizes the risk of cuts and bleeding, which is critical for a client on warfarin.
A) Applying lanolin or petroleum jelly is not directly related to improving tissue perfusion.
D) Limiting ADLs is incorrect, as moderate activity promotes circulation unless contraindicated.