NCLEX-RN
Health Promotion NCLEX RN Nursing Questions Questions
Extract:
Question 1 of 5
The nurse provides information to a client about performing a breast self-examination (BSE). The nurse determines that the client needs additional teaching if the client makes which statements? Select all that apply.
Correct Answer: B,D,E
Rationale: Any lumps in the armpit or nipple discharge are abnormal and require reporting to a healthcare provider. The BSE should be performed 2 to 3 days after menstruation ends, not on the first day, when breasts are tender. Monthly BSE, palpation with soapy water in the shower, and mirror inspection are correct techniques.
Question 2 of 5
The nurse is teaching dietary modifications to the client with hypertension. The nurse should instruct the client to eat which snack foods?
Correct Answer: A,B
Rationale: Sodium should be avoided by the client with hypertension. Fresh fruits and vegetables such as carrots and celery are naturally lower in sodium. Hypertensive clients are also advised to keep fat intake to less than 30% of their total calories as part of prudent heart living. Each of the incorrect options contains high amounts of sodium, and frozen pizza and cheese and crackers are also likely to be higher in fat.
Question 3 of 5
The home care nurse suspects that a client's spouse is experiencing caregiver strain. Which action should the nurse take to assess for this condition?
Correct Answer: B
Rationale: Caregiver strain can occur when a client is significantly dependent on the caregiver for personal and health care needs. The nurse gathers data from the client and the caregiver to determine the caregiver's stressors and coping abilities and withholds making any referrals until the assessment is complete and the plan of care is in place. Because the nurse suspects caregiver strain, the nurse fulfills the duty to the client and family by approaching the family with the concern, gathering assessment data, and planning care. The nurse does not expect the client to assess the coping abilities of the caregiver because assessment is part of the nursing process and should not be delegated.
Question 4 of 5
The nurse is instructing a client diagnosed with type 1 diabetes mellitus about the management of hypoglycemic reactions. The nurse instructs the client that hypoglycemia most likely occurs during what time interval after insulin administration?
Correct Answer: A
Rationale: Insulin reactions are most likely to occur during the peak time after insulin administration, when the medication is at its maximum action. Peak action depends on the type of insulin, the amount administered, the injection site, and other factors.
Question 5 of 5
The nurse is reviewing the medication history for a 24-year-old client in the fertility clinic. Which medication does the nurse understand to be a Category X medication in pregnancy?
Correct Answer: D
Rationale: Simvastatin is Category X, contraindicated in pregnancy due to fetal harm. Others are safer (Categories B or
C).