Version 2

1. The nurse shows a teenager how to use a metered dose inhaler of

ipratropium (Atrovent). Which statement, if made by the client to the

nurse, indicates teaching iseffective?

1. “I should use this medicine to stop the coughing that leads to an

asthma attack”

2. “I should use this medicine if I begin to have an asthma attack”

3. “I should use this medicine right after I have an asthma attack”

4. “I should use this medicine to prevent an

asthma attack”Answer#2

2. An older client is scheduled for a magnetic resonance imaging MRI

procedure. Which ofthe following statements, if made by the client to the

nurse, should be reported to the technician before the test?

1. “I take medication to control my blood pressure”

2. “I have had diabetes for about 10 years now”

3. “I had a knee replacement 5 years ago”

4. “I am allergic to penicillin and sulfa


3. The nurse makes the following observations of a 6 hour old newborn:

axillary temperature 96.4 F (35.8 C), apical pulse 148, respirations

irregular at 48/minute, blacksticky stool, blood glucose 60mg/dL. It is

most important for the nurse to take which action?

1. Feed the newborn 30mL of infant formula

2. Administer low flow oxygen to the newborn

3. Wrap the newborn in a warmed blanket

4. Perform a guaiac test on the

newborns stoolAnswer#3

4. A client is returned to the unit at 10AM after laparoscopic gallbladder

surgery. Thenurse plans to get the patient out of bed for the first time

at 4PM. It is MOST important for the nurse to take which of the

following actions?

1. Turn the patient from side to side at 2 PM

2. Offer pain medication to the patient at 3:30PM

3. Encourage the patient to use the incentive spirometer at 3PM

4. Cough and deep-breathe the patient at


5. The activity therapy staff takes a group of psychiatric patients on a trip to

the zoo. Thenurse should intervene with which of the following patients

before their departure?

1.A 50 year old female who is having difficulty with sleeping,

eating, and socialinteraction.

2.A 40 year old male who just received his third dose of trazodone

(Desyrel) and is 20pounds overweight.

3.A 42 year old female who has problems with decision making who paces

continuously, wringing her hands.

4.A 38 year old female who is receiving chlorpromazine (Thorazine) and

is wearing asundress without a hat or sunglasses.

Answer#4 (photosensitivity;causes sensitivity to sun)

6.A patient experiences skin eruptions due to an allergic reaction to a

medication. Thenurse demonstrates the BEST documentation with which

of the following?

1.“Patient complains of rash and itching over most of his body. Patient

is concernedabout how it looks”

2.“Multiple red welts noted over trunk and both arms. Patient states that

welts itch”

3.“Allergic skin reaction to medication experienced by patient. Started

several hoursago”

4.“Vital signs stable. Patient scratching arms and chest area


7.An older client diagnosed with emphysema is admitted to the

psychiatric unit for treatment of bipolar disorder. The client receives

oxygen per nasal cannula. The clientexpresses concern to the nurse that

someone will come in and change the amount of oxygen the client is

receiving. INITIALLY, the nurse should take which of the following


1.Schedule an in-service with the staff about emphysema

2.Place a sign above the patient’s bed stating that the oxygen level

is not to bechanged

3.Tell the patient she will be well cared for in the hospital

4.Convey the patient’s concern to the

nursing staffAnswer#2

8.A teenager has a positive home pregnancy test and comes to the prenatal

clinic. The girl is uncertain of the date of her last menstrual period. The nurse

palpates the uterine fundus midway between the symphysis pubis and the

umbilicus. Which statement by the nurseis BEST?

1.“You are 24 weeks pregnant. It is good that you came in for prenatal care”

2.“You are 30 weeks pregnant. Prenatal care is important for you and your


3.“You are 16 weeks pregnant. Let’s talk about what that means”

4.“You are 8 weeks pregnant. Are your periods usually


9.A client is admitted to the psychiatric unit with complaints of fatigue,

inability to concentrate, lack of appetite, and repetitive thoughts. The client

is reluctant to take the prescribed medications, fearing that they are

harmful. After the nurse gives the client themedication, the nurse should

take which of the following actions?

1.Instruct the client to open her mouth and move her tongue up and down

and to eachside while the nurse looks inside.

2.Ask the client if she has swallowed the medication completely.

3.Watch the client’s behavior to see if the medication is having its desired


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Version latest
Category NCLEX(both rn and pn)
Included files pdf
Authors qwivy.com
Pages 65
Language English
Comments 0
Sales 0
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