Missed NCLEX PREPU

A client with chronic obstructive pulmonary disease (COPD) is being evaluated for a lung transplant. Which initial assessment data would the nurse anticipate? Select all that apply. a. decreased respiratory rate b. dyspnea on exertion c. barrel chest d. shortened expiratory phase e. unintended weight loss f. fever

b, c, e

A nurse is assessing a client who has just been admitted to the emergency department. Which signs suggest an overdose of an antianxiety agent? a. combativeness, sweating, and confusion b. agitation, hyperactivity, and grandiose ideation c. slurred speech, dyspnea, and impaired coordination d. suspiciousness, dilated pupils, and increased blood pressure

c. Signs of antianxiety agent overdose include slurred speech, dyspnea, and impaired circulation. Phencyclidine (PCP) overdose can cause combativeness, sweating, and confusion. Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation. Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure.

What is the onset of codeine?

30 minutes

A nurse is teaching a client with osteomalacia how to take ordered vitamin D supplements. Which adverse effects should the nurse instruct the client to report? a. GI upset and metallic taste b. dry skin, hair loss, and inflamed mucous membranes c. flushing and orthostatic hypotension d. sensory neuropathy and difficulty maintaining balance

a The nurse should instruct the client to report GI upset and metallic taste because these are early signs and symptoms of vitamin D toxicity. Such toxicity also may cause headache, weakness, renal insufficiency, renal calculi, hypertension, arrhythmias, muscle pain, and conjunctivitis. Dry skin, hair loss, and inflamed mucous membranes suggest vitamin A toxicity. Flushing and orthostatic hypotension (effects of vasodilation) may result from nicotinic acid and nicotinamide supplements, which are used to correct niacin deficiency. Sensory neuropathy and difficulty maintaining balance suggest pyridoxine toxicity.

The client reports concerns regarding use of patient-controlled analgesia (PCA). Which response(s) by the nurse would most likely decrease the client's anxiety regarding the PCA? Select all that apply. a. "The PCA has a greater client satisfaction with pain management." b. "The PCA provides better pain management than PRN medications." c. "The PCA yields earlier discharge." d. "The PCA decreases complications." e. "The PCA helps attain early ambulation."

a, b, e The nurse should relay to the client that PCA helps with early ambulation, provides better pain management, and contributes to greater client satisfaction. Use of PCA does lead to earlier discharge or decrease in complications so this should not be communicated to the client.

A nurse is considering employment at a hospital where nurses belong to a collective bargaining unit. How will the potential employee benefit from the collective bargaining unit? Select all that apply. a. free collective bargaining membership b. negotiation for wages c. negotiation for improved work environment d. preferred work hours and childcare accommodations e. organization of social activities

b, c, e Nurses who belong to a collective bargaining unit will have negotiation for wages and improved work environments. Collective bargaining units may sponsor social activities for members. The collective bargaining unit does not help with preferred work hours or childcare. The membership for a collective bargaining unit is not free; dues for membership are required.

A nurse is caring for a client with schizoaffective disorder. The client is scheduled for the first round of electroconvulsive therapy (ECT). What is the priority nursing action post-ECT? a. withholding food and fluids for 12 hours b. maintaining bed rest for 8 hours c. performing a respiratory assessment d. assessing the client's skin for burns

c ECT is used to reduce the severity of psychiatric symptoms by delivering an electrical stimulus to a client's brain. Prior to ECT, the client is given sedative medications. Priority assessments post-ECT should focus on airway, breathing, and circulation. The client may eat, drink, and get out of bed as soon as the client feels comfortable and vital signs (including level of consciousness) are within normal limits. Assessing the client's skin for burns is an appropriate nursing action; however, assessing breathing is the priority.

Important teaching for a client receiving risperidone should include advising the client to: a. maintain a therapeutic level by doubling a dose if the client misses a dose. b. be sure to take the drug with a meal because it can severely irritate the stomach. c. discontinue the drug if the client gains weight. d. notify the physician if the client notices an increase in bruising.

d Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. The client shouldn't double the drug dose. This drug doesn't irritate the stomach, and weight gain isn't an adverse effect of risperidone therapy.

While providing care to a client, the nurse notes multiple blue, purple, and yellow ecchymotic areas on the arms and trunk. When the nurse asks about these bruises, the client responds, "I tripped." What actions would the nurse take? Select all that apply. a. Document the client's statement and complete a body map indicating the size, color, shape, location, and type of injuries. b. Contact the local authorities to report suspicions of abuse. c. Assist the client in developing a safety plan for times of increased violence. d. Arrange a meeting with the partner to discuss the situation. e. Instruct the client to leave the abusive situation as soon as possible. f. Provide the client with telephone numbers of local shelters and safe houses.

a, c, f The nurse would objectively document the assessment findings. A detailed description of physical findings of abuse in the medical record is essential if legal action is pursued. All individuals, men or women, suspected of being abuse victims would be counseled on a safety plan, which consists of recognizing escalating violence within the family, formulating a plan to exit quickly, and knowing the telephone numbers of local shelters and safe houses. The nurse would not report this suspicion of abuse because the client is a competent adult who has the right to self-determination. Contacting the client's partner to arrange a meeting without consent violates confidentiality. The nurse would respond to the client in a nonthreatening manner that promotes trust, rather than ordering the client to break off the relationship.

X-rays reveal a leg fracture in a client who was brought to the emergency department after falling on ice. After a cast is applied and allowed to dry, the nurse teaches the client how to use crutches. Which instruction should the nurse provide about climbing stairs? a. "Place both crutches on the first step and swing both legs upward to this step." b. "Place the unaffected leg on the first step, followed by the crutches and the injured leg, which should move together." c. "Place the crutches and injured leg on the first step, followed by the unaffected leg." d. "Place the injured leg and the crutch on the unaffected side on the first step; the unaffected leg and crutch on the injured side follow."

b When climbing stairs with crutches, the client should lead with the unaffected leg, followed by the crutches and injured leg moving together. Any other method is incorrect and could increase the client's risk of falling.

One day after being admitted with bipolar disorder, a client becomes verbally aggressive during a group therapy session. Which response by the nurse is most therapeutic? a. "You're behaving in an unacceptable manner, and you need to control yourself." b. "If you continue to talk like that, no one will want to be around you." c. "Your behavior is disturbing to other clients. I'll walk with you to help you release some energy." d. "You're scaring everyone in the group. Leave the room immediately."

c. This response shows that the nurse finds the client's behavior unacceptable, yet still regards the client as worthy of help. Also, the nurse is recommending an appropriate alternative to the client's inappropriate behavior. The other options critique the client's behavior and offer no appropriate alternative.

Client admitted to the emergency department with severe upper quadrant pain radiating to the back, nausea and vomiting, and fever. Laboratory results received via telephone as follows: glucose 462 mg/dL, WBC 14,000, lipase 214, calcium 6.5 A client has been admitted to the emergency department with severe mid-epigastric, upper quadrant abdominal pain. Based on the signs and symptoms and laboratory data documented in the chart, the nurse would anticipate preparing for which diagnosis? peptic ulcer Crohn's disease pancreatitis irritable bowel syndrome

d The assessment findings combined with the laboratory results suggest pancreatitis. The pancreas is situated behind the stomach in the upper quadrant. Signs and symptoms of pancreatitis include severe mid-epigastric, upper quadrant abdominal pain, fever, nausea, and vomiting. Inflammation of the pancreas results in leukocytosis. Injured ?-cells are unable to produce insulin, leading to hyperglycemia, which may be as high as 500 to 900 mg/dl (27.75 to 49.95 mmol/L). Lipase and amylase levels become elevated as the pancreatic enzymes leak from injured pancreatic cells. Calcium becomes trapped as fat necrosis occurs, leading to hypocalcemia. Peptic ulcer, Crohn's disease, and irritable bowel syndrome do not cause amylase or lipase levels to increase.