Random Nclex Study

A client has been diagnosed with pernicious anemia. In planning care for the client, the nurse anticipates that the client will be treated with which? 1. Iron 2. Folic acid 3. Thiamine 4. Vitamin B12

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The nurse is preparing to administer medication through a nasogastric (NG) tube that is connected to suction. Which indicates the accurate procedure for medication administration? 1. Position the client supine to assist with medication absorption. 2. Clamp the NG tube for 30 minutes after medication administration. 3. Aspirate the NG tube after medication administration to maintain patency. 4. Change the suction setting to low intermittent suction for 30 minutes after medication administration.

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The nurse is preparing to deliver a food tray to a client whose religion is Judaism. The nurse checks the food on the tray and notes that the client has received a roast beef dinner with whole milk as a beverage. Which action should the nurse take? 1. Deliver the food tray to the client. 2. Replace the whole milk with fat-free milk. 3. Call the dietary department and ask for a new meal tray. 4. Ask the dietary department to replace the roast beef with pork.

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The nurse is preparing to suction a client through a tracheostomy tube. The nurse should avoid which action when performing this procedure? 1. Preoxygenating the client before suctioning 2. Moistening the catheter tip in sterile saline solution before suctioning 3. Introducing the catheter into the tracheostomy tube using a sterile gloved hand 4. Placing suction on the catheter while introducing the catheter into the tracheostomy tube

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The nurse is providing care to a Cuban-American client who is terminally ill. Numerous family members are present most of the time, and many of the family members are very emotional. Which nursing action is most appropriate? 1. Restrict the number of family members visiting at one time. 2. Inform the family that emotional outbursts are to be avoided. 3. Contact the health care provider to speak to the family regarding their behavior. 4. Request permission to move the client to a private room, and allow the family members to visit.

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The nurse is providing dietary instructions to a client with gout. The nurse should tell the client to avoid which food item? 1. Scallops 2. Chocolate 3. Cornbread 4. Macaroni products

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A client receiving enteral feedings develops abdominal distention and diarrhea shortly after initiation of the feedings. In review of the nursing history for this client, which of these notations indicates the need to notify the health care provider? 1. Difficulty swallowing 2. History of hemorrhoids 3. History of enteral feedings 4. Lactose intolerance since childhood

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The nurse is reinforcing instructions to a client on how to decrease the intake of potassium in the diet. The nurse should tell the client that which food contains the least amount of potassium? 1. Lettuce 2. Potatoes 3. Apricots 4. Avocados

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A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The health care provider inserts a nasogastric tube and prescribes a tube feeding of a standard formula feeding to run at 50 mL/hr. The nurse plans care, knowing that which is true regarding enteral feedings? 1. Enteral feedings are a frequent cause of sepsis. 2. Tube feedings should be refrigerated until just before use. 3. The caloric value of enteral feedings is generally 5 to 10 kcal/mL. 4. Enteral feedings require the normal digestive capabilities of the gastrointestinal (GI) tract.

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A client is seen in the clinic for a physical examination. Laboratory studies are performed and reveal that the hemoglobin and hematocrit are low, indicating the need for further diagnostic studies and a blood transfusion. The client is a Jehovah's Witness and refuses to have a blood transfusion. Which should be an appropriate action by the clinic nurse? 1. Try to convince the client of the need for the transfusion. 2. Support the client's decision not to receive a blood transfusion. 3. Speak to the family regarding the need for a blood transfusion. 4. Discuss with the client the results of the low hemoglobin and hematocrit levels.

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A client with chronic pain has been taught how to operate a transcutaneous electrical nerve stimulation (TENS) unit. Which action by the client shows understanding of the appropriate use of the device when the level of stimulation is uncomfortable? 1. The client shuts off the device immediately. 2. The client increases the device settings slightly. 3. The client adjusts the setting downward slightly. 4. The client adjusts the setting downward by half.

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A postoperative client has been placed on a clear liquid diet. Which items is the client allowed to consume? Select all that apply. 1. Broth 2. Coffee 3. Gelatin 4. Pudding 5. Ice cream 6. Vegetable juice

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A seriously ill client in the hospital tells the nurse that he thinks he has lost some of his ability to hear over the past few days. The nurse reviews the medications the client is currently receiving. Which medications are known to be ototoxic? Select all that apply. 1. Aspirin 2. Furosemide (Lasix) 3. Penicillin (Pen VK) 4. Dilantin (Phenytoin) 5. Gentamycin (Garamycin) 6. Docusate sodium (Colace)

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After attending the same social function 5 days ago, 50 individuals arrive at the hospital over a 4-day period with fever; an itchy, reddish brown papule; and complaints of nausea, vomiting, and severe abdominal pain. Cutaneous anthrax is suspected by the health care team. Which is the nurse's priority for client care? 1. Institute contact precautions. 2. Dispense the recommended vaccine. 3. Administer ciprofloxacin (Cipro). 4. Check vital signs every 15 minutes.

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An older postoperative client has been tolerating a full liquid diet, and the nurse plans to advance the diet to solid food as prescribed. The nurse collects data regarding which important item before advancing the diet to solids? 1. Ability to chew 2. Food preferences 3. Cultural preferences 4. Presence of bowel sounds

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The nurse at a well-baby clinic is providing nutrition instructions to the mother of a 1-month-old infant. What instruction should the nurse give to the mother? 1. Introduce strained fruits one at a time. 2. Introduce strained vegetables one at a time. 3. Offer breast milk or formula as the main food. 4. Offer rice cereal mixed with breast milk or formula.

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The nurse educator is describing the yin and yang theory of the ancient Chinese philosophy of Tao to a group of nursing students. The nurse educator explains that in this theory, foods are classified as hot and cold and are transformed into yin and yang energy when metabolized by the body. The nursing student understands this theory when the student makes which statement? 1. The client believes that yin foods are hot foods. 2. The client believes that yang foods are cold foods. 3. The client consumes hot foods when a "hot" illness is present. 4. The client consumes cold foods when a "hot" illness is present.

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The nurse instructs a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse tells the client that which food provides the least amount of potassium? 1. Apple 2. Carrots 3. Spinach 4. Apricots

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The nurse is assigned to assist in caring for a client who is receiving parenteral nutrition with fat emulsion. The nurse is instructed to monitor the client for signs of fat overload. The nurse monitors for which signs and symptoms of this complication?

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The nurse is assigned to care for a client experiencing episodes of postural hypotension. Which action should the nurse take to ensure safety while transferring the client from the bed to the chair? 1. Arrange for a transfer board to be used. 2. Perform the transfer using a hydraulic lift only. 3. Put the client's shoes on to help the client avoid slipping on the floor during the transfer. 4. Allow the client to dangle the legs in a sitting position on the bed before transfer to a chair.

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The nurse is assisting with collecting data from an African-American client admitted to the ambulatory care unit who is scheduled for a hernia repair. Which information about the client is of least priority during the data collection? 1. Respiratory 2. Psychosocial 3. Neurological 4. Cardiovascular

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The nurse is comparing the use of nalbuphine (Nubain) versus meperidine (Demerol) for pain management for a pregnant client. Which statement is true with regard to the use of nalbuphine or meperidine? 1. Meperidine is effective in creating an amnesic effect. 2. Meperidine is less likely to cause nausea and vomiting. 3. Nalbuphine can be used for a client with an opioid dependency. 4. Nalbuphine is less likely to cause significant respiratory depression.

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The nurse is reinforcing diet teaching for a client on a low-sodium diet for hypertension. The nurse determines that the client needs further teaching when the client makes which statement? 1. "This diet will help lower my blood pressure." 2. "The reason I need lower salt intake is to reduce fluid retention." 3. "This diet is not a replacement for my antihypertensive medications." 4. "Canned foods are inexpensive and are good to use on a low-sodium diet."

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The nurse is reinforcing instructions to a client regarding how to decrease the intake of phosphorus in the diet. The nurse should tell the client that which food item contains the least amount of phosphorus? 1. Fish 2. Oranges 3. Almonds 4. Whole-grain bread

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The nurse knows that spatial behavior is related to territoriality in many Latino cultures. Which client needs are associated with territoriality? Select all that apply. 1. Utility 2. Privacy 3. Security 4. Autonomy 5. Self-identity 6. Philosophy

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The nurse prepares to administer a prescribed dose of scopolamine (Transderm-Scōp). The nurse should monitor for which side effect of this medication? 1. Dry mouth 2. Diaphoresis 3. Excessive urination 4. Pupillary constriction

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The nurse who is assisting in conducting a weight loss program prepares to monitor a client's weight. The nurse understands that which data most accurately determines the effectiveness of weight loss? 1. Daily weights 2. Calorie counts 3. Serum protein levels 4. Daily intake and output

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Which statement made by the nursing student indicates a need for further teaching by the nursing instructor on the concept of ethnocentrism? 1. "It is a tendency to view one's own ways as best." 2. "It is believing that one's own ways are the only acceptable way." 3. "It is imposing one's beliefs on individuals from another culture." 4. "It is acting in a manner in which one's culture is superior to other cultures."

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A client who has calcium phosphate kidney stones tells the nurse, "Tell me what I can do, so that I never have this pain again." Which instructions should the nurse plan to include in the reinforcement of dietary instructions? Select all that apply. 1. Avoid spinach. 2. Decrease sodium intake. 3. Limit the intake of organ meats. 4. Limit the intake of whole grains. 5. Limit protein to 5 to 7 servings per week.

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