NCLEX-PN
Health Promotion and Maintenance NCLEX PN Questions Questions
Extract:
Question 1 of 5
The LPN is preparing a client for discharge, and the discharge medications include phenobarbital. Which of these client statements would indicate a need for reinforced teaching about this medication?
Correct Answer: C
Rationale: The correct answer is, "I can't wait to get back to my nightly glass of wine,"? as phenobarbital should not be taken with alcohol as it is a barbiturate. Alcohol may increase the sedative effect, posing risks to the patient's safety.
Choice A, "I will need to avoid eating excessive leafy greens,"? is unrelated to phenobarbital and not a cause for reinforced teaching.
Choice B, "It's best to take this medication with food,"? is a general instruction and not specific to phenobarbital.
Choice D, "I should try to take this medication at the same time every day,"? is a common recommendation for medication adherence but does not highlight a specific concern related to phenobarbital.
Question 2 of 5
While assisting with data collection on a client, a nurse hears a bruit over the abdominal aorta. What action should the nurse prioritize based on this finding?
Correct Answer: C
Rationale: Detection of a bruit over the aorta during abdominal assessment may indicate the presence of an aneurysm. The nurse's priority action should be to notify the healthcare provider to further evaluate the situation. Palpating the area or percussing the abdomen could potentially increase the risk of an aneurysm rupture. While documenting the finding is important, the priority is to ensure timely intervention by involving the healthcare provider.
Question 3 of 5
A nurse assisting with data collection is preparing to auscultate the client's bowel sounds. The client tells the nurse that he ate lunch just 45 minutes ago. On the basis of this information, which finding does the nurse expect to note?
Correct Answer: A
Rationale: Bowel sounds are high-pitched, gurgling, cascading sounds that occur irregularly between five and 30 times a minute. In this scenario, since the client ate lunch just 45 minutes ago, the nurse would expect to note gurgling sounds as normal bowel activity. Hypoactive sounds (low-pitched) or an absence of sounds are usually associated with conditions such as abdominal surgery or inflammation of the peritoneum, not with recent food intake.
Therefore, the correct answer is gurgling sounds, indicating normal bowel activity following a recent meal.
Question 4 of 5
Which of the following actions should the LPN perform for a client with an active digoxin IV order? Select all that apply.
Correct Answer: D
Rationale: The correct actions for the LPN to perform for a client with an active digoxin IV order are to monitor ECG rhythm throughout administration and monitor the client's pulse for 1 minute prior to administration. These actions are crucial as digoxin affects the heart's electrical activity, and it should not be administered if the client's pulse is less than 60 bpm. Monitoring respirations and blood pressure are not directly associated with digoxin administration. Administering IV medications is typically outside the LPN's scope of practice.
Question 5 of 5
When a client and their family are facing the end stage of a terminal illness, where might they be best served?
Correct Answer: C
Rationale: When a client and their family are facing the end stage of a terminal illness, they are best served by Hospice. Hospice offers a more humanized alternative care for dying clients compared to hospitals, focusing on comfort and quality of life in the final stages of life. It provides a specialized interdisciplinary team of health care professionals who work together to manage client care.
Choices A, B, and D are incorrect because a rehabilitation center focuses on physical therapy, an extended care facility provides long-term care for activities of daily living, and a crisis intervention center deals with immediate psychological or social crises, none of which cater to the specific needs of clients facing the end stage of a terminal illness.