NCLEX RN Prep U Comfort

A 16-year-old boy who is academically gifted is about to graduate from high school early since he has completed all courses needed to earn a diploma. Within the last 3 months he has begun to experience panic attacks that have forced him to leave classes early and occasionally miss a day of school. He is concerned that these attacks may hinder his ability to pursue a college degree. What would be the best response by the school nurse who has been helping him deal with his panic attacks?

"It sounds like you have a real concern about transitioning to college. I can refer you to a health care provider for assessment and treatment." The client's concerns are real and serious enough to warrant assessment by a health care provider (HCP) rather than being dismissed as trivial. Though he is very intelligent, his intelligence cannot overcome his anxiety, and in fact, his anxiety is likely to interfere with his ability to perform in college if no assessment and treatment is received. Just postponing college is likely to increase the client's anxiety rather than lower it since it does not address the panic he is experiencing.

A client with chronic renal failure who receives hemodialysis three times a week is experiencing severe nausea. What should the nurse advise the client to do to manage the nausea? Select all that apply.

- Have limited amounts of fluids only when thirsty. - Keep all dialysis appointments. - Eat smaller, more frequent meals. To manage nausea, the nurse can advise the client to drink limited amounts of fluid only when thirsty, eat food before drinking fluids to alleviate dry mouth, encourage strict follow-up for blood work, dialysis, and health care provider (HCP) visits. Smaller, more frequent meals may help to reduce nausea and facilitate medication taking. The client should be as active as possible to avoid immobilization because it increases bone demineralization. The client should also maintain the dialysis schedule because the dialysis will remove wastes that can contribute to nausea.

The nurse is caring for a client in labor. The client wishes to have a "nonmedicated" labor and birth. During the early stages of labor, the client becomes frustrated with the use of music and imagery. Which of the following would the nurse include in the client's plan of care? Select all that apply.

-Encourage ambulation -Suggest a shower or bath -Offer the use of a yoga ball This client has asked for a nonmedicated labor and birth. As the client advocate, the nurse should offer nonmedicated interventions and options. Encouraging ambulation, suggesting shower or bath, or offering the use of a yoga ball are nonmedication interventions appropriate for this stage of labor. Offering an epidural or giving IV pain medication, does not support the client in their choice of care.

The nurse is assessing a client experiencing a sickle cell crisis who continues to rate the pain at 10 on a scale of 1 to 10. Which is true about pain?

Expression and perception of pain vary widely from person to person. Pain perception is an individual experience. Current evidence indicates that pain tolerance and perception vary widely among individuals, even within cultures. A person's genetic makeup is not a determinant of pain perception or tolerance.

During a prenatal visit, a health care provider decides to admit a client to the hospital. Based on the nurse's progress note, which complication of pregnancy would the health care provider suspect?

Hyperemesis gravidarum. Hyperemesis gravidarum is severe nausea and vomiting that persists after the first trimester. If untreated, it can lead to weight loss, starvation, dehydration, fluid and electrolyte imbalances, and acid-base disturbances. The client may report thirst, hiccups, oliguria, vertigo, and headache. A rapid pulse and elevated or subnormal temperature can also occur. Signs and symptoms of iron-deficiency anemia include fatigue, pallor, and exercise intolerance. Placenta previa causes painless, bright red, vaginal bleeding after 20 weeks of pregnancy. Pregnancy-induced hypertension usually develops after 20 weeks of pregnancy; the client reports sudden weight gain and presents with hypertension.

When developing the postoperative plan of care for a child who is scheduled to have a tympanostomy tube inserted into the right ear, which intervention should the nurse identify to facilitate drainage?

Position the child to lie on the right side. Positioning the child on the affected side, in this case the right side, will promote drainage from the middle ear by gravity. Application of heat, such as in the form of warm compresses, may facilitate drainage of exudate from the ear but only if the child is lying on the affected side. A gauze dressing is not applied after surgery. However, a loose wick may be inserted into the external ear canal to absorb drainage from the right, not left, ear. Application of an ice bag may help reduce pressure and edema. However, the ice bag would be applied to the right ear.

A nurse is caring for a severely depressed client who is barely functioning. The priority nursing goal for this client would be to:

assess for and maintain adequate nutrition and hydration. Food and fluid intake may be compromised in a client who is severely depressed. The nurse must ensure that the client is adequately hydrated and is receiving proper nutrition. Although the client's psychological needs are important, physiological needs are the priority in this case. Assessing the client's depression level, continuing the client's ordered medication, and maintaining the client's hygiene needs are lower priorities at this time. The nurse should be aware that family involvement may not be indicated in this client's care.

A client has been taking prescribed aspirin in large doses and reports having stomach irritation, sometimes with vomiting. Which food or beverage noted from the client's diet history should the nurse suggest the client avoid?

glass of wine Gastrointestinal irritation is a common side effect of aspirin, especially when taken in large doses. Such signs and symptoms as anorexia, nausea, vomiting, diarrhea, and constipation are also common. The combination of aspirin and alcohol is especially likely to cause gastrointestinal irritation, sometimes to the point of doing direct damage to gastric mucosa. Dry toast, eggs, and sweetened tea are not gastrointestinal irritants.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the treatment of musculoskeletal conditions. It is important for the nurse to remind the client to:

take NSAIDs with food. NSAIDs irritate the gastric mucosa and should be taken with food. NSAIDs are usually taken once or twice daily. Joint exercise is not related to the drug administration. Antacids may interfere with the absorption of NSAIDs.

A client with chronic cancer pain has been receiving opiates for 4 months. She rated the pain as an 8 on a 10-point scale before starting the opioid medication. Following a thorough examination, there is no new evidence of increased disease, yet the pain is close to 8 again. The most likely explanation for the increasing pain is:

tolerance to the opioid. Tolerance to an opioid occurs when a larger dose of the analgesic is needed to provide the same level of pain control. The risk of addiction is low with opioids to treat cancer pain. There are no data to support that this client is experiencing withdrawal. Although the client may have experienced a placebo effect at one time, placebo effects tend to diminish over time, especially in regard to chronic cancer pain.