NCLEX-PN
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies Questions
Extract:
Question 1 of 5
The nurse is caring for a group of clients all in need of pain medication. The nurse has determined the most appropriate pain medication for each client based on the client's level of pain. Prioritize the order that the nurse should plan to administer the pain medications, beginning with the most potent analgesic for the client with the most severe pain.
Correct Answer: B,D,C,A,E
Rationale: B: Fentanyl 0.1 mg IV bolus per PCA. Fentanyl (Sublimaze), the most potent of the medications, is an opioid narcotic analgesic that binds to opiate receptors in the CNS, altering the response to and perception of pain. A dose of 0.1 to 0.2 mg is equivalent to 10 mg of morphine sulfate. D: Morphine sulfate 4 mg IV. Morphine sulfate is also an opioid analgesic. This dose is IV and would be fast-acting. C: Hydromorphone 5 mg oral. Hydromorphone (Dilaudid), another opioid analgesic, would be next in priority. The oral dosing of this medication would indicate that the client's pain is less severe than the client receiving fentanyl or morphine sulfate. Hydromorphone 7.5 mg oral is an equianalgesic dose to 30 mg of oral morphine or 10 mg parenteral morphine. A: Ketorolac 10 mg oral. Ketorolac (
Toradol) is an NSAID and nonopioid analgesic that inhibits prostaglandin synthesis, producing peripherally mediated analgesia. E: Propoxyphene 65 mg oral. Propoxyphene (Darvon) should be given last. It binds to opiate receptors in the CNS but is used in treating mild to moderate pain. It has analgesic effects similar to acetaminophen's.
Question 2 of 5
During surgery, it is found that a client with adenocarcinoma of the rectum has positive peritoneal lymph nodes. What is the next most likely site of metastasis?
Correct Answer: C
Rationale: Rectal adenocarcinoma commonly metastasizes to the liver via the portal vein and lymphatics, making it the most likely next site.
Question 3 of 5
The LPN needs to determine the client's respiratory rate. What is the best technique to do this?
Correct Answer: D
Rationale: You should not tell the client you are counting their respirations, as this may cause them to alter their breathing pattern. Pretending to check a pulse allows you to get close to the client without cluing them in to what you are assessing. Standing across the room is not the best way to assess for respirations as they may be difficult to see.
Question 4 of 5
Why must the nurse be careful not to cut through or disrupt any tears, holes, bloodstains, or dirt present on the clothing of a client who has experienced trauma?
Correct Answer: C
Rationale: Trauma in any client, living or dead, has potential legal and/or forensic implications. Clothing, patterns of stains, and debris are sources of potential evidence and must be preserved. Nurses must be aware of state and local regulations that require mandatory reporting of cases of suspected child and elder abuse, accidental death, and suicide. Each Emergency Department has written policies and procedures to assist nurses and other health care providers in making appropriate reports. Physical evidence is real, tangible, or latent matter that can be visualized, measured, or analyzed. Emergency Department nurses can be called on to collect evidence. Health care facilities have policies governing the collection of forensic evidence. The chain of evidence custody must be followed to ensure the integrity and credibility of the evidence. The chain of evidence custody is the pathway that evidence follows from the time it is collected until is has served its purpose in the legal investigation of an incident.
Question 5 of 5
Which of the following should not be included in the teaching for clients who take oral iron preparations?
Correct Answer: A
Rationale: Iron should not be mixed with antacids, as antacids can reduce iron absorption. The other options are appropriate: taking with meals can reduce GI distress, using a straw prevents tooth discoloration, and juice enhances absorption while milk can inhibit it.