NCLEX-RN
Saunders NCLEX RN Practice Questions Questions
Extract:
Question 1 of 5
Mr. W has orders for a physical therapy consult. The nurse contacts the appropriate department but 12 hours later, no one has come to see the client. Which is the most appropriate action of the nurse?
Correct Answer: D
Rationale: The most appropriate action for the nurse in this scenario is to contact the physical therapy department again and repeat the order (
Choice
D). This is the correct answer because it directly addresses the issue of the consult not being completed within a reasonable timeframe. By contacting the department again, the nurse ensures that the order is not overlooked or forgotten. This action shows proactive communication and follow-up to expedite the process and ensure the client receives the necessary care in a timely manner.
The other choices are incorrect:
A: Calling the supervisor and filing a complaint is premature without first attempting to resolve the issue directly with the department.
B: Contacting the physician is not the nurse's role in this situation. The focus should be on coordinating with the appropriate department.
C: Assessing the client's activity level is important but does not address the primary issue of the physical therapy consult not being completed.
Overall, choice D is the most appropriate course of action in this scenario.
Question 2 of 5
Examples of preservation of self-integrity include all of the following except:
Correct Answer: C
Rationale: The correct answer is C: Accepting the challenge of caring for clients with oppositional beliefs or practices. This choice does not align with preservation of self-integrity as it may require compromising personal values or beliefs. Using assistive equipment (
A) promotes safety, participating in wellness programs (
B) supports personal well-being, and using hand hygiene and PPE (
D) ensures infection control. Accepting clients' opposing beliefs may lead to internal conflict, compromising self-integrity.
Question 3 of 5
A nurse is required to float to another unit within the hospital where he is asked to care for a client on a ventilator. The nurse is uncomfortable with this assignment, as he has not had a ventilated client since nursing school. What is the nurse's most appropriate response?
Correct Answer: A
Rationale: The correct answer is A: Explain to the nursing supervisor the level of discomfort and ask for a different assignment. This is the most appropriate response because the nurse is being transparent about their discomfort and seeking a solution to ensure quality care for the client. By communicating concerns, the nurse can potentially be given a more suitable assignment or receive additional training. Option B is incorrect as it is important for nurses to continuously learn and adapt to new situations within their scope of practice. Option C is not ideal as the nurse should not take on a task they are uncomfortable with without proper support. Option D is not the best choice as it does not address the issue directly with the supervisor.
Question 4 of 5
What is involved in obtaining informed consent?
Correct Answer: A
Rationale: The correct answer is A because obtaining informed consent involves providing the client with an explanation of the reasons for the procedure. This ensures that the client understands the purpose, risks, benefits, and alternatives of the procedure before giving consent.
Choice B is incorrect because a signature on a form alone does not guarantee informed consent.
Choice C is incorrect as affirming liability is not a necessary component of obtaining informed consent.
Choice D is incorrect as it combines an essential element (
A) with an incorrect element (
C).
Question 5 of 5
A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which group of the following medications would the patient most likely be started on?
Correct Answer: A
Rationale: The correct answer is A: Aripiprazole (Abilify). In this scenario, the patient is experiencing paranoid delusions, a symptom commonly associated with psychotic disorders. Aripiprazole is an atypical antipsychotic that is often used to treat symptoms of psychosis, including delusions. It is a preferred choice because it has a lower risk of side effects compared to typical antipsychotics like fluphenazine. Risperidone, another atypical antipsychotic, could also be considered, but aripiprazole is often preferred due to its side effect profile. Fluoxetine, an antidepressant, is not the ideal choice for treating psychotic symptoms.
Therefore, aripiprazole is the most appropriate medication in this case.