random nclex questions

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55 terms Jessica_Laderman5 Preview Q Revie 101 term eer what is the rinne test?a hearing test, primarily used to evaluate hearing loss in one ear.what is two point discriminationassesses tactile sense. the ability to discern that two nearby objects touching the skin are truly two distinct points, not one. It is often tested with two sharp points during a neurological examination A nurse has just inserted an indwelling foley catheter in a client scheduled for surgery. What should the nurse document?perineal skin assessment urine quality, quantity, and odor client teaching date and time type catheter inserted what is an anticholinergic agent that is used for extrapyramidal effects caused by meds such as haloperidol?benztropine what is atropine?This is an anticholinergic agent, but not one commonly used to treat pseudoparkinsonism, a form of extrapyramidal side effects. It is commonly used to treat arrhythmias and preoperatively to decrease secretions.what is chlorpromazine?an antipsychotic medication when do you give kayexalate?when potassium is high what signs and symptoms will the nurse look for when monitoring an infant client for dehydration?amber colored urine fussiness tachypnea no tears when crying

what is a blakemore tub?medical device inserted through nose or mouth that compresses against gastrointestinal junction and reduces blood flow to esophageal varices you have a 6th month old patient being admitted with acute gastroenteritis. what room assignment is most appropriate?private room, because gastroenteritis is contagious, so if at all possible, place the child in a private room, so other children would be less likely to contract the gastroenteritis what info should be included in the health promotion plan for parents of toddlers regarding the promotion of adequate bowel elimination in toddlers?include adequate fiber in the diet through whole grains and fruits increase intake of water daily provide toileting opportunities that are free from distractions encourage the toddler to go to the bathroom at least three times daily what is the frontal lobe responsible for?motor control, ability to speak words, concentration, memory, and judgment give a function of the parietal lobe?decreased sensation what is a function of the occipital lobe?impaired vision what is a function of the temporal lobe?decreased hearing what is the purpose of recieving methotrexate? this medication will stop the growth of the embryo to save the fallopian tube what vaccines are recommended for older adults? flu herpes zoster diptheria pertussis pneumococcoal vaccine A child is brought into the emergency department (ED) after accidently ingesting 3 grams of acetylsalicylic acid.Initial assessment reveals lethargy, excessive sweating, hyperventilation, and hyperthermia. What interventions should the nurse initiate?since the client has hyperthermia you should

• provide tepid water sponge bath
• start an Iv for fluid resuscitation
• insert an NG tube
• pad side rails
• obtain blood gases

What room assignment by the charge nurse is most appropriate for a client with a history of biliary atresia who is being admitted with poor appetite, malaise, and temperature of 101.5ºF (38.6ºC)?in this particular situation, a private room is best due to elevated temperature. this could mean the client has an infection and is contagious The nurse is assessing the injection site of a healthy client who received a Mantoux skin test 48 hours ago. Which finding at the injection site indicates a need for further evaluation?15 mm induration because an induration of 15 mm or greater is usually considered significant in people who have normal or mildly impaired immunity A female client taking captopril for hypertension tells the clinic nurse that she is planning to get pregnant. What recommendation should the nurse make?"Captopril can cause serious harm to an unborn baby, so you must prevent pregnancy while taking this medication. "

After drawing up insulin for subcutaneous administration, the nurse receives a return phone call from a healthcare provider who wants to give prescription orders on a new admit. The nurse asks a new nurse to administer the insulin dose. What action should the new nurse take?Tell the nurse that whoever draws up the medication has to administer that medication.A school nurse is caring for a child who fell on the playground. Upon examination of the child, the nurse notes multiple bruises in various stages of healing. What is the nurse's initial intervention?Contact the Department of Health and Human Services.The emergency department called the LDR to give report on a 24 year old primigravida at term, having contractions every 5-8 minutes. The unit is very busy, and all the RNs are with other clients. What action by the charge nurse would be most appropriate?Instruct the LPN/VN to obtain initial vital signs and connect the client to a fetal monitor, then report this data to the charge nurse.obtaining vital signs and placing clients on electronic fetal monitors are within the scope of practice of LPN/VN.A clinic nurse is educating a client diagnosed with Bell's Palsy. What is the most important educational point the nurse must emphasize to the client?Proper methods of closing eyelids and eye patching.The nurse is caring for a male client who presents to the mental health unit following a violent altercation his wife.He has numerous bruises on his face, chest, and back. He has one laceration where she "came at me" with a knife. At this time, what is most likely to be the mood of the perpetrator in this situation?Calm The perpetrator has completed the acute battering phase and has now likely entered the honeymoon phase with extreme kindness and acts of love. She is now calm after the tension has been released.What precautions should the nurse plan for when admitting a client diagnosed with measles?place a surgical mask on the client when transferring to x-ray initiate airborne precautions do not assign non-immune nurses to care for client A client comes to the clinic reporting palpitations, as well as nausea and vomiting while taking metronidazole. The nurse notes that the client is flushed and has a heart rate of 118 bpm. Based on this information, what is the most important question for the nurse to ask the client?"Are you using any products that contain alcohol?" The nurse is caring for a client taking sprionolactone.Which snack choices would indicate to the nurse that the client understands proper dietary choices while on this medication?apples and grapes A nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000/mm3. What would be the priority nursing assessment?level of consciousness The platelet level is at the "panic" level. The client is at risk for a cerebral hemorrhage. Assessing the LOC takes priority because this is the answer that is most life threatening.

The nurse approaches a client who entered the emergency department following a fall down a flight of stairs. The client is unresponsive with snoring and wheezes with respirations. How would the nurse best open the client's airway?Jaw thrust maneuver This is a trauma client that could possibly have a C-spine injury. The jaw thrust maneuver will open the client's airway without manipulating the client's C-spine A female client has used Depo-Provera injections for birth control for several years. For the past 6 months, attempts to become pregnant have been unsuccessful.What instruction should the nurse provide to the client?Ovulation ceases with Depo-Provera use. It may take 6 to 18 months to reestablish normal ovulation and menstruation.What should the nurse instruct a client to avoid when prescribed digoxin?Black licorice contains a natural ingredient called glycyrrhiza, which can deplete the body of potassium while causing an increased retention of sodium. When the body is depleted of potassium, the activity of digoxin, can be greatly enhanced, resulting in digoxin toxicity.The nurse is preparing a client for transport to the radiology department for a left lung tissue biopsy. Which actions should the nurse make certain have been completed?The nurse should ensure that the consent form is signed, the lab work is in order, and any ordered preoperative medication is given. The operative site is marked by the person who is ultimately accountable for the procedure and will be present when the procedure is performed. If possible, involve the client in the site- marking process The nurse is teaching the family of a newly diagnosed diabetic client about treatment of hypoglycemia at home.Which guidelines should be given to the family of the client?Treat a mild episode with 10-15 grams of carbohydrate.A community health nurse, participating in a health fair, is educating a community group about risk factors for developing varicose veins. What risk factors should the nurse include?Sitting or standing for prolonged periods of time, obesity, female gender, wearing high-heeled shoes.The client at the mental health center has voiced suicidal thoughts and has access to firearms at home. Which action by the nurse is priority?Inform the family and ask them to remove the guns.A client in labor is placed on an external fetal monitor.Which interventions should the nurse perform if a late fetal heart rate deceleration occurs?Late fetal heart rate decelerations are associated with fetal hypoxia and acidosis.Positioning the mother on her left side prevents compression of the vena cava.Oxygen administration increases maternal, then fetal blood level, thus treating current and preventing further development of hypoxia and acidosis. Failure to recognize fetal monitoring strip abnormalities and failure to report abnormalities to the primary healthcare provider are deviations from the standard of care.A client diagnosed with cancer has been losing weight.What should the nurse teach the client regarding methods for improving nutritional needs to maintain weight?Butter and oils added to foods adds calories. This client needs more calories and more protein. Spread peanut butter or other nut butters, which contain protein and healthy fats, on toast, bread, apple or banana slices, crackers or celery. Use croissants or biscuits to make sandwiches which provides more calories. Add powered creamer or dry milk powder to hot cocoa, milkshakes, hot cereal, gravy, sauces, meatloaf, cream soups, or puddings to add more calories. Top hot cereal with brown sugar, honey, dried fruit, cream or nut butter.