NCLEX RN Exam Review Answers - Nurselytic

Correct Answer: C

Rationale: A key principle of patient teaching that ensures patient safety is the confirmation of understanding.
To ensure patient safety, it is crucial to confirm that the patient comprehends the information provided. This confirmation can be achieved by having the patient repeat back the information or demonstrate understanding through return demonstration. Documenting the patient's understanding is essential to track the effectiveness of the teaching session and ensure that the patient is equipped with the necessary knowledge for their safety. Family members being present or having multiple staff members provide teaching may be beneficial in certain situations, but the primary focus should be on confirming the patient's understanding to enhance safety and promote effective learning.

Correct Answer: D

Rationale: Forming a peer workgroup to evaluate new products would be an excellent opportunity for collaboration among peers, management, and the purchasing department. When clinicians are engaged to work toward solutions that address patient care issues, they experience more empowerment and control over their work environments.

Choice A is incorrect because using old stock from a previous company does not address the root cause of the faulty transducers from the current company.
Choice B is incorrect as verifying cuff pressures every hour does not directly address the issue of faulty transducers.
Choice C is less effective than forming a peer workgroup as it involves only notifying the risk manager without involving a collaborative effort to resolve the product issue.

Correct Answer: A

Rationale: Intrapersonal conflict involves negative feelings or frustrations within oneself. It may be related to decisions or actions that clash with personal morals or beliefs.
Choice A is the correct answer because the nurse is experiencing guilt due to administering medication that causes a client to have negative side effects, which reflects an internal struggle.

Choices B, C, and D do not represent intrapersonal conflict.
Choice B involves a legal obligation,
Choice C is related to external factors like working overtime, and
Choice D pertains to a conflict with a colleague.

Correct Answer: A

Rationale: Collegiality is the action of forming relationships and supporting others through work experiences. In this scenario, the nurse being promoted as a mentor and preceptor exemplifies collegiality by fostering an encouraging educational relationship with the new nursing staff. The nurse demonstrates appropriate nursing care, teaches skills, and supports the professional growth of others.
Choice B, 'Competence,' refers to having the necessary skills and knowledge, but in this context, the focus is on the supportive and educational role of the nurse.
Choice C, 'Advocacy,' involves speaking up for patients' rights and needs, which is not directly demonstrated in the scenario.
Choice D, 'Integration,' does not directly relate to the situation described, where the emphasis is on mentoring and guiding new staff.

Correct Answer: D

Rationale: Diarrhea and vomiting are manifestations of lithium toxicity. The priority action for the nurse is to hold the next dose of lithium and obtain an order for a stat serum lithium level to confirm toxicity. This ensures patient safety and prevents further harm. Recognizing it as a drug interaction is not the first step in this scenario. Cogentin is used to manage extrapyramidal symptoms (EPS) associated with antipsychotics, not lithium toxicity. Reassuring the client about these symptoms as common side effects of lithium therapy is inappropriate as they indicate a more serious issue than typical side effects like hand tremors, nausea, polyuria, and polydipsia.