NCLEX-PN
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies Questions
Extract:
Question 1 of 5
The nurse has completed swaddling the 2-month-old infant, prepared supplies to cannulate the scalp vein for an IV infusion, and cleansed and shaved the hair at the site over the temporal bone. Place the remaining steps in the order that they should be performed by the nurse.
Correct Answer: C,A,D,B,F,E
Rationale: C: Apply lidocaine/prilocaine (EML
A) cream to the site selected and unswaddle the infant after the cream application. An anesthetic cream will numb the site and help reduce the infant's pain during insertion. The infant does not need to remain swaddled while the cream reaches its therapeutic effectiveness in about an hour. A: Return in 60 minutes and reswaddle the infant in a mummy restraint. It takes about an hour for the lidocaine/prilocaine cream to reach its therapeutic effectiveness. The infant should be reswaddled to minimize movement during insertion. D: Cleanse the shaved area with an antiseptic solution. Cleansing the area with an antiseptic solution will help prevent inadvertent introduction of microorganisms into the vascular system. B: With an assistant holding the infant's head, insert a scalp vein needle and observe for blood return. Movement of the infant's head can result in loss of the vein access or a needle-stick injury to the infant or nurse. F: Initiate the infusion and cover the infusion needle with a gauze dressing. Once the vein has been successfully cannulated, the site can be dressed and IV fluids started. E: Remove the mummy restraint after initiating the infusion and comfort the infant. The mummy restraint is no longer needed after the IV catheter has been successfully inserted into a scalp vein.
Question 2 of 5
The nurse is caring for an elderly client and providing education. Which of the following would be least appropriate?
Correct Answer: A
Rationale: The nurse should not speak in a loud voice just because the client is elderly. The nurse should assess the client for a hearing impairment to see if additional assistance is required. However, elderly clients tend to require more time to process information, since their reaction time is slower, and they may benefit from more frequent, shorter sessions as they fatigue easily. Elderly clients are usually capable of absorbing supplemental written resources.
Question 3 of 5
Which spot is the safest place to administer an IM injection to an infant? Select the correct corresponding letter from the attached graphic.
Correct Answer: B
Rationale: The vastus lateralis muscle, highlighted by the letter B, should be used in infants as the muscle tends to be thickest in this area.
Question 4 of 5
The client is experiencing delirium from substance withdrawal. Which medication, if prescribed prn, should the nurse administer to help calm the client?
Correct Answer: D
Rationale: Lorazepam (Ativan) depresses the CNS, reducing anxiety and calming the client during withdrawal.
Question 5 of 5
The LPN is taking care of a client who is on Phenelzine (Nardil) for depression. Which meal would the nurse encourage the client to avoid?
Correct Answer: B
Rationale: Phenelzine (Nardil) is a type of MAOI (Monoamine Oxidase Inhibitor). Clients on these drugs should avoid foods and beverages with large amounts of tyramine, as they may cause dangerous elevations in blood pressure. Common foods high in tyramine include aged meats and cheeses, beer, sauerkraut, and soy sauce.