NCLEX-RN
Free NCLEX RN Questions on Health Promotion and Maintenance Questions
Extract:
Question 1 of 5
Which factors increase the risk for hypothermia in an older client? Select all that apply.
Correct Answer: A,B,C,D,F
Rationale: The median oral temperature of an older client is 96.8^{\circF}\left(36^{\circC}\right) . Environmental temperatures below 65^{\circF}\left(18^{\circC}\right) may cause a serious drop in core body temperature to 95^{\circF}\left(35^{\circC}\right) or less in the older client. Numerous factors increase the risk of hypothermia in the older client, including conditions that increase heat loss (e.g., burns); conditions that decrease heat production such as hypothyroidism, hypoglycemia, or anemia; medications or substances that interfere with thermoregulation, such as alcohol; or thermoregulatory impairment (failure to sense cold).
Question 2 of 5
The clinic nurse provides home care instructions to a mother regarding the care of her child who is diagnosed with croup. Which statement by the mother indicates the need for further instructions?
Correct Answer: B
Rationale: The mother needs to be instructed that cough syrup and cold medicines should not be administered because they may dry and thicken secretions, worsening croup symptoms. Acetaminophen (Tylenol) is appropriate for reducing fever. Sips of warm fluids help relax the vocal cords and thin mucus. A cool-mist humidifier is recommended to keep the air moist and reduce airway irritation.
Question 3 of 5
The nurse provides instructions regarding home care to a parent of a 3-year-old child who has been hospitalized with hemophilia. Which statement by the parent indicates the need for further teaching?
Correct Answer: C
Rationale: Immunizations are important for children with hemophilia to prevent infections, and the parent's statement about avoiding them indicates a misunderstanding. Not leaving the child unattended, padding table corners, and removing tippable items are appropriate safety measures to prevent bleeding injuries.
Question 4 of 5
The nurse has completed instructions regarding diet and fluid restriction for the client diagnosed with chronic kidney disease. The nurse determines that the client understands the information presented if the client selected which dessert from the dietary menu?
Correct Answer: D
Rationale: For fluid-restricted diets in chronic kidney disease, clients should avoid foods liquid at room temperature like Jell-O, sherbet, and ice cream, which count as fluid intake. Angel food cake is a solid dessert, allowing more fluid intake by drinking to alleviate thirst.
Question 5 of 5
Cyclophosphamide is prescribed for the client diagnosed with breast cancer, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates the need for further teaching?
Correct Answer: C
Rationale: Cyclophosphamide can cause hemorrhagic cystitis, requiring copious fluid intake (2–3 liters/day) to prevent it, not fluid restriction. Hair regrowth, reporting sore throat (indicating infection), and avoiding live virus vaccine contacts are correct due to immunosuppression.