NCLEX-PN
Health Promotion and Maintenance NCLEX PN Questions
1. Why is Kleinman's Explanatory Model of Health and Illness significant?
- A. it focuses on the health beliefs of a particular family.
- B. it highlights the impact of culture on health explanations.
- C. it discusses the significant role of popular and folk domains of influence.
- D. it is based on an educational approach.
Correct answer: C
Rationale: Kleinman's Explanatory Model of Health and Illness is significant because it emphasizes the influence of popular and folk domains on health perceptions. Kleinman distinguishes between disease, representing the biomedical view, and illness, reflecting individual understanding. The model underscores that cultural factors shape the significance of popular and folk influences on health beliefs. Choice A is incorrect as the model focuses on broader cultural influences, not individual family beliefs. Choice B is incorrect as it oversimplifies the model's emphasis on various cultural aspects. Choice D is incorrect as the model's significance lies in its cultural framework rather than an educational base.
2. The LPN is admitting a client to the unit, and the client has rapidly blinking eyes, a stuck-out tongue, and a distorted posture. Which of these medications is the client most likely taking?
- A. Clozapine
- B. Fluoxetine
- C. Ondansetron
- D. Haloperidol
Correct answer: D
Rationale: The correct answer is Haloperidol. Haloperidol is a first-generation antipsychotic that blocks dopamine receptors and is most likely to cause extrapyramidal symptoms (EPS), such as tardive dyskinesia. Symptoms of tardive dyskinesia include rapid blinking, mouth movements, sticking out the tongue, rapid body movements, and a distorted posture. Haloperidol is associated with a higher risk of EPS compared to other antipsychotic medications like Clozapine. Clozapine is known for having a lower risk of causing EPS. Fluoxetine is a selective serotonin reuptake inhibitor used for depression and anxiety, not typically associated with these movement disorder symptoms. Ondansetron is an antiemetic used to prevent nausea and vomiting, not linked to these extrapyramidal symptoms.
3. A nurse assisting with data collection is preparing to auscultate for bowel sounds. The nurse should use which technique?
- A. Begin in the right lower quadrant.
- B. Use the bell end of the stethoscope.
- C. Hold the stethoscope lightly against the skin.
- D. Listen for at least 5 minutes before deciding that bowel sounds are absent.
Correct answer: A
Rationale: To auscultate for bowel sounds, the nurse should use the diaphragm end piece of the stethoscope as bowel sounds are relatively high pitched. The stethoscope should be held lightly against the skin to avoid stimulating more bowel sounds. The nurse should begin in the right lower quadrant at the ileocecal valve, where bowel sounds are normally present. It is recommended to listen for 5 minutes before deciding that bowel sounds are absent to ensure a thorough assessment. Choice B is incorrect because the bell end is used for low-pitched sounds such as heart sounds. Choice C is incorrect as holding the stethoscope firmly and deeply can cause unnecessary bowel sound stimulation. Choice D is incorrect as listening for 1 minute is insufficient to determine the presence or absence of bowel sounds.
4. A nurse is supervising a student in preparing the physical environment for an interview with a client. Which action by the student is correct?
- A. Setting the room temperature at a comfortable level
- B. Placing a chair for the client across from the nurse's desk
- C. Providing seating for the client so that the client faces a strong light
- D. Setting up seating so that the client and nurse are not at eye level
Correct answer: A
Rationale: When preparing the physical environment for an interview with a client, it is crucial to ensure the client's comfort. Setting the room temperature at a comfortable level is essential for the client's well-being. Additionally, providing privacy, sufficient lighting, and removing distractions are crucial factors. It is recommended to maintain a distance of around 4 to 5 feet between the client and the nurse. Seating should be arranged so that the client and nurse are at eye level to facilitate effective communication and prevent barriers. Placing a chair across from the nurse's desk may create a physical barrier, positioning the client to face a strong light can be uncomfortable and distracting, and setting up seating so that the client and nurse are not at eye level may impede effective communication.
5. The LPN is preparing a client for discharge, and the discharge medications include phenobarbital. Which of these client statements would indicate a need for reinforced teaching about this medication?
- A. "I will need to avoid eating excessive leafy greens."?
- B. "It's best to take this medication with food."?
- C. "I can't wait to get back to my nightly glass of wine."?
- D. "I should try to take this medication at the same time every day."?
Correct answer: C
Rationale: The correct answer is, "I can't wait to get back to my nightly glass of wine,"? as phenobarbital should not be taken with alcohol as it is a barbiturate. Alcohol may increase the sedative effect, posing risks to the patient's safety. Choice A, "I will need to avoid eating excessive leafy greens,"? is unrelated to phenobarbital and not a cause for reinforced teaching. Choice B, "It's best to take this medication with food,"? is a general instruction and not specific to phenobarbital. Choice D, "I should try to take this medication at the same time every day,"? is a common recommendation for medication adherence but does not highlight a specific concern related to phenobarbital.
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