NCLEX-PN
NCLEX-PN Quizlet 2023 Questions
Extract:
Question 1 of 5
Which of the following observations is most important when assessing a client's breathing?
Correct Answer: C
Rationale: The correct answer is the presence of breathing and adequacy of breathing. It is crucial not only to confirm that the client is breathing but also to ensure that the breathing is adequate for proper oxygenation.
Choices A, B, and D are incorrect because while pulse rate, breathing pattern, and patient position are relevant aspects to consider, the most critical observations in assessing a client's breathing are the presence and adequacy of breathing.
Question 2 of 5
While assessing a patient in the ICU, a nurse observes signs of a weak pulse, quick respiration, acetone breath, and nausea. Which of the following conditions is most likely occurring?
Correct Answer: B
Rationale: The correct answer is a hyperglycemic patient. The signs described - weak pulse, quick respiration, acetone breath, and nausea - are indicative of hyperglycemia. A hypoglycemic patient would typically present with different signs such as pale skin, sweating, and confusion. Cardiac arrest would manifest with sudden loss of heart function and consciousness, not the signs described. End-stage renal failure would present with symptoms related to kidney dysfunction like edema, fatigue, and changes in urine output, which are not mentioned in the scenario.
Question 3 of 5
How can the nurse promote relief of muscle pain, spasms, and tension?
Correct Answer: C
Rationale:
To promote relief of muscle pain, spasms, and tension, the nurse should consider applying heat, cold, pressure, or vibration to the painful area. These interventions can help alleviate pain associated with muscle tension, pain, or spasms.
Choice A is incorrect because encouraging the client to continue their activities as usual may exacerbate the pain.
Choice B is incorrect as immobilizing the client may not address the underlying issue and could potentially lead to further complications.
Choice D is also incorrect because while pain medication can be used, it is not the first-line treatment for muscle pain, spasms, and tension.
Question 4 of 5
A nurse is caring for a client with an elevated cortisol level. The nurse can expect the client to exhibit symptoms of:
Correct Answer: C
Rationale: Elevated cortisol levels can lead to sodium and fluid retention and potassium deficit, resulting in urinary deficit. This imbalance in electrolytes and fluid can cause a decrease in urinary output.
Choices B, hyperpituitarism, and D, hyperthyroidism, are incorrect as they do not directly relate to the symptoms expected with elevated cortisol levels. Option A, urinary excess, is also incorrect as high cortisol levels typically lead to fluid retention and urinary deficit, not excess.
Question 5 of 5
A pregnant Asian client who is experiencing morning sickness wants to take ginger to relieve the nausea. Which of the following responses by the nurse is appropriate?
Correct Answer: A
Rationale: The correct response is to offer to consult with the physician regarding the use of ginger, showing cultural sensitivity. Ginger is known to help relieve nausea, especially in pregnancy.
Choice A is the correct answer as it respects the client's preference for a home remedy and involves the physician in the decision-making process.
Choice B dismisses the client's preference for a home remedy without exploring its potential benefits.
Choice C makes a generalized statement discrediting the effectiveness of herbs, which is not evidence-based and disregards the client's beliefs.
Choice D offers an alternative without addressing the client's specific request, failing to acknowledge the client's autonomy and cultural background.