NCLEX-PN
2024 Nclex Questions Questions
Extract:
Question 1 of 5
Before administering Theodur to a 10-year-old being treated for asthma, the nurse should check the:
Correct Answer: C
Rationale: The correct answer is to check the pulse. Theodur is a bronchodilator used in asthma treatment, and one of the side effects is tachycardia (increased heart rate).
Therefore, it is essential to assess the pulse rate before administering Theodur to monitor for any potential tachycardia. Checking urinary output (
Choice
A), blood pressure (
Choice
B), and temperature (
Choice
D) are not directly related to the immediate side effects of bronchodilators like Theodur in this context, making them unnecessary assessments.
Question 2 of 5
A client goes to the mental health center for difficulty concentrating, insomnia, and nightmares. The client reports being raped as a child. The nurse should assess the client for further signs of:
Correct Answer: C
Rationale: Given the history of childhood sexual abuse and the presenting symptoms of difficulty concentrating, insomnia, and nightmares, the nurse should assess the client for post-traumatic stress disorder (PTS
D). Childhood sexual abuse is strongly associated with adult-onset depression and an increased risk for PTSD. Individuals with PTSD may exhibit re-experiencing symptoms such as flashbacks, nightmares, and heightened reactions to trauma triggers. They may also display emotional numbing, avoidance behaviors, and increased arousal symptoms like difficulty sleeping and hypervigilance. Generalized anxiety disorder (
Choice
A) is characterized by excessive worry and anxiety about various events or activities, not necessarily tied to a specific trauma. Schizophrenia (
Choice
B) is a severe mental disorder characterized by distortions in thinking, perception, emotions, and behavior, unrelated to the traumatic event described. Bipolar disorder (
Choice
D) involves mood swings between depressive and manic episodes, and its symptoms differ from those typically seen in PTSD.
Question 3 of 5
An adolescent female reports being raped at a party where alcohol was served. The client admits to drinking alcohol before being raped by an acquaintance. The nurse should:
Correct Answer: C
Rationale: In cases of rape, it is crucial to provide support and reassurance to the victim. The nurse should inform the client that it was not her fault and offer support through the physical examination. Blaming the victim, as in choice A, is inappropriate and can be damaging to the client's well-being.
Choice B is not the priority at this moment; the immediate focus should be on supporting the client.
Choice D is victim-blaming and implies doubt about the client's report, which is harmful and not supportive. It is essential to create a safe and supportive environment for the client to facilitate healing and recovery.
Question 4 of 5
The client is diagnosed with multiple myeloma. The doctor has ordered cyclophosphamide (Cytoxan). Which instruction should be given to the client?
Correct Answer: D
Rationale: Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis, a condition characterized by inflammation of the bladder wall leading to bleeding.
To prevent this complication, the client should drink at least eight glasses of water a day. Walking to prevent calcium loss (choice
A) and increasing fiber intake (choice
B) are not directly related to the side effects of Cytoxan, making them unnecessary instructions in this case. While nausea is a common side effect of chemotherapy, the immediate reporting of nausea to the doctor (choice
C) is important but not specifically related to the use of Cytoxan in this scenario.
Question 5 of 5
Activities of effective supervisors can be task-related or people-related activities. An example of a task-related supervisory activity is:
Correct Answer: C
Rationale: Delegating is the act of assigning work to those capable and competent to do the work, making it a task-related supervisory activity. Coaching, evaluating, and facilitating are people-related supervisory activities. Coaching involves guiding and developing individuals, evaluating entails assessing performance, and facilitating focuses on enabling tasks and processes. These activities are more centered on interacting with and supporting people rather than directly assigning tasks.
Therefore, in the context of task-related activities, delegating stands out as the correct choice.