a hospitalized adult client who routinely works from midnight until 8 am has a temperature of 991 f at 4 am the nurse determines that this is most lik
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Nursing Elites

NCLEX-PN

Nclex Exam Cram Practice Questions

1.

Correct answer: D

Rationale:

2. A case manager is reviewing notations made in clients' records. Which note indicates an unexpected outcome and the need for immediate follow-up?

Correct answer: A

Rationale: A case manager is responsible for coordinating a client's care and monitoring for unexpected outcomes. The situation that indicates an unexpected outcome and the need for immediate follow-up is when a client exhibits signs of increased intracranial pressure after a craniotomy. This indicates a deteriorating condition that requires urgent intervention. Choices B, C, and D describe expected outcomes or normal findings related to specific conditions, which do not demand immediate follow-up.

3. When observing a dressing change by a graduate nurse on a Stage III pressure ulcer to the greater trochanter by the staff nurse, a need for further teaching is indicated after the following observation by the nurse:

Correct answer: B

Rationale: The correct answer is that the new graduate irrigates the pressure ulcer with half-strength hydrogen peroxide. Pressure ulcers should not be cleaned with substances that are cytotoxic, such as hydrogen peroxide or betadine. This can cause further damage to the wound and delay the healing process. Choice A is incorrect because irrigating the pressure ulcer with normal saline is an appropriate practice. Choice C is incorrect because packing the wound with sterile kerlix soaked in normal saline is also an appropriate step. Choice D is incorrect because applying a Duoderm dressing after cleansing is a standard procedure in wound care.

4. A client admitted to the hospital has a do-not-resuscitate (DNR) order in his medical record. The nurse understands which information about DNR orders?

Correct answer: D

Rationale: The correct answer is that the DNR order requires frequent review as specified by state or agency policy. If the client's condition changes, the DNR order may need to be changed. For this reason, DNR orders require frequent review as specified by state or agency policy. A DNR order may be changed at any time and does not remain in effect for the duration of the client's hospitalization. The client's request regarding DNR status is the priority. Choice A is incorrect because healthcare providers, not just immediate family members, may change the DNR order based on the client's condition. Choice B is incorrect as DNR orders can be changed if the client's condition warrants it, not remaining unchanged. Choice C is incorrect as DNR orders are not fixed for the duration of hospitalization, they can be modified based on the client's needs.

5. The client has asked if you would be able to offer any alternative or complementary therapy during their hospitalization. Which of the following would be appropriate to suggest?

Correct answer: B

Rationale: Music therapy is an appropriate suggestion as an alternative or complementary therapy during hospitalization. Music therapy can help improve the client's condition and comfort level by providing emotional support and reducing stress. Physical therapy and occupational therapy are crucial for rehabilitation and improving physical function, while psychiatric therapy focuses on mental health treatment. These therapies are essential components of care but are not typically considered alternative or complementary therapies in this context.

Similar Questions

What information does the healthcare provider remember regarding do-not-resuscitate (DNR) orders in this scenario?
A client is refusing to stay in the hospital because he does not agree with his healthcare treatment plan. The nurse stops the client from leaving due to concern for his health. Which of these legal charges could the nurse face?
What is a significant point about Shigella that the nurse should acknowledge upon identifying it in a stool culture?
The client is going for surgery and mentions their religious objection to blood transfusions. Which of the following responses would be most appropriate?
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