Simple Nursing NCLEX-PN

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NCLEX PN ARCHER REVIEW

689 terms ervan_valdezPreview simple 40 terms mad Which suggestion(s) will the nurse offer to a patient who is in their first trimester of pregnancy reporting difficulty sleeping at night due to epigastric pain? Select all that apply.

• Do not consume any yogurt while you are pregnant.
• Increase the amount of fat in your diet.
• Increase fluid intake in between and with all meals
• Try eating small amounts of dark chocolate after every

meal

• Try tp eat 4-6 meals a day instead of large meals
• Try tp eat 4-6 meals a day instead of large meals

The nurse is caring for a patient that has been diagnosed with ulcerative colitis and is currently experiencing daily episodes of bloody diarrhea. What should the nurse recommend adding to the patient's plan of care? Select all that apply.

• Begin monitoring intake and output at least hourly
• Consult a dietician to discuss the patient's compliance
• Offer time for the patient to verbalize feelings

regarding illness.

• Promote the patient with high-fat, low protein foods

during the day.

• Begin monitoring intake and output at least hourly
• Consult a dietician to discuss the patient's compliance
• Offer time for the patient to verbalize feelings regarding illness.

The nurse recognizes that teaching needs to be reinforced when the mother of a 15 month old makes a statement regarding dietary needs of a child this age?

• "My child does not like vegetables juice but each

chopped vegetables."

• "My child is used to falling asleep with a cup of milk."
• "I give my child the recommended amount of water

each day."

• "I always wait one week between each new food

offered."

• "My child is used to falling asleep with a cup of milk.

The LPN is reviewing pre-procedure instructions with a client scheduled for a heart catheterization procedure.The client takes metformin daily for diabetes mellitus.What instructions does the LPN give the client regarding the metformin?

• "You may take the metformin on the morning of the

procedure, but only take a small sip of water with it."

• "Take the last dose of metformin the day before the

procedure and then resume it the day after the procedure."

• "Check your blood glucose the morning of the

procedure. Hold the metformin if you blood glucose is <150>

• "Stop taking the metformin 48 hours before the test,

and restart it as directed to by the health care provider (HCP)."

• "Stop taking the metformin 48 hours before the test, and restart it as directed to

by the health care provider (HCP)." The nurse is reinforcing teaching to parents of a toddler newly diagnosed with type 1 diabetes mellitus. What should be the primary educational outcome of teaching?

• Establish adequate coping mechanisms.
• Learn how maintain stable blood sugars.
• Know how to perform meal preparation.
• Recognition the need for follow up visits.
• Learn how maintain stable blood sugars.

The practical nurse is caring for 4 clients. Which client requires immediate intervention?

• Client with recent abdominal surgery who refuses to

turn., cough, nd deep breathe

• Client hospitalized with a femur fracture reporting

sudden shortness of breath and chest pain

• Client with a head injury who requires hourly neuro

checks; last neuro check was 45 minutes ago and GCS was 15

• Client hospitalized with a femur fracture reporting sudden shortness of breath

and chest pain Rationale: The client that requires immediate intervention is the client hospitalized with a femur fracture reporting sudden shortness of breath and chest pain. This client is exhibiting signs of a pulmonary embolism, and the health care provider (HCP) should be notified immediately.

Which teaching needs to be reinforced about a new prescription of lisinopril? Select all that Apply

• Include Bananas, oranges, cantaloupe, honeydew, and

apricots for the patient to add to their diet.

• Instruct the patient to sit on the side of the bed before

minutes before standing up in the morning.

• Review the apical pulse monitoring video with patient

and do teach back demonstration

• Remind the patient to return to have daily blood draws

to determine therapeutic drug levels

• Teach the patient how to obtain an apical pulse and

hold medication if <60>

• Review the blood pressure monitoring video with

patient and do a teach back demonstration.

• Instruct the patient to sit on the side of the bed before minutes before standing

up in the morning.

• Review the blood pressure monitoring video with patient and do a teach back

demonstration.

Rationale: The focus of this question is understanding patient education for

lisinopril.While giving report, the nurse realizes that the oncoming nurse has the smell of alcohol on her breath and isn't acting like herself. What is the most appropriate action for the nurse to take?

• Not say anything to her, but ask a coworker that will be

there for the next shift to make sure she isn't impaired.

• Tell the nurse to go home because she isn't fir for duty

at this time

• Stop the handoff and report the issue to the charge

nurse

• Asl the nurse how much she has had to drink and if she

is able to do her job today or not

• Stop the handoff and report the issue to the charge nurse

A nurse is reviewing a patient's medical history prior to administering the 0900 medications. Which finding would be most concerning and the nurse should consult with the charge nurse before administration of labetalol 100 mg?

• History of tachycardia

2, History of anxiety

• History of asthma
• History of essential hypertension
• History of asthma

Rationale: 3. History of asthma

Which physical examination finding would support the assessment findings of this laboring mother?

Assessment findings:

Report of needing to bear down Nausea and vomiting Legs observed are trembling Knuckles are white while holding bed rails

• 4 cm dilated and 40?faced, -3 station.
• 7 cm dilated and 60 effaced, -1 stationed
• 8 cm dilated, 0?faced, 0 station.
• 9 cm dilated, 100?faced, + 3 station
• 9 cm dilated, 100?faced, + 3 station

rationale: The focus of this question is understanding times the nurse should hold a medication and discuss concerns with the charge nurse.

Which assessment finding from a 35 year old male patient taking methotrexate 30 mg PO should the nurse consider priority?*Select All That Apply

• Avoiding oral contraceptives.
• Ammonia level of 17 mcg/dL
• Drinking 4-5 energy drinks each day.
• Petechiae all over the body.
• Platelet count of 85,0000 cells/mm3
• Reports of bleeding gums after brushing teeth
• Petechiae all over the body.
• Platelet count of 85,0000 cells/mm3
• Reports of bleeding gums after brushing teeth

Which patient prescription(s) should the nurse discuss with the charge nurse? Select all that apply.

• Esomeprazole 40 mg IV prescribed for a patient with

peptic ulcer disease and gastrointestinal bleed.

• Fidaxomicin 200 mg PO prescribed for a patient with

Clostridium difficile colitis.

• Atenolol 50 mg PO prescribed to a patient with

hypertension and a blood pressure of 92/46 mm Hg

• Oxacillin 500 mg PO prescribed to a patient with otitis

media and prior amoxicillin allergy

• Regular insulin 6 units subcutaneous prescribed to a

diabetic patient with 300 mg/dL blood glucose.

• Prednisone 20 mg prescribed to a patient with primary

adrenal insufficiency.

• Atenolol 50 mg PO prescribed to a patient with hypertension and a blood

pressure of 92/46 mm Hg

• Oxacillin 500 mg PO prescribed to a patient with otitis media and prior

amoxicillin allergy

rationale: Migraines can cause the client to become dizzy and nauseated. The

nurse will assist the client to ambulate, to prevent falls and make sure the client is in a dark quiet room, with as little light as possible, til the migraine subside.A nurse is caring for a client with a severe migraine..Which action would require retraining by the charge nurse?

• Have the client do neck stretches/rolls
• Turn the lights off in the clients room and keep the

door closed

• Assist the client to ambulate
• Turn on the client's TV
• Have the client do neck stretches/rolls

Which statement by the nurse is most critical for the nurse to make to the parents of a recently deceased child?

• "I know this will be difficult but will your child be an

organ donor?"

• "We are now going to clean and prepare your child to

be viewed."

• "I recommend making an appointment with your

provider as soon as possible to discuss the loss."

• "We are here for you. Take all the time and privacy that

you need with your child."

• "We are here for you. Take all the time and privacy that you need with your

child." Rationale: The grief after the death of a child can be unbearable and the loss will forever change a parent. However, if mourning becomes a constant state, the parent may be experiencing complicated grief.