Nclex question review
Which statement by a nursing student about Kohlberg's theory of moral development indicates the need for further teaching about the theory?
"Individuals move through all six stages in a sequential fashion."
Several children have contracted measles (rubeola) in a local school, and the nurse provides information to the mothers of the children about this communicable disease. Which statement by a mother indicates a need for further teaching?
"The symptoms increase in severity after the rash appears."
The nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?
Apply a moisturizing lotion to dry feet, but not between the toes.
The nurse reinforces instructions to a group of clients regarding measures that will assist with the prevention of skin cancer. Which statement by a client indicates the need for further teaching?
I need to avoid sun exposure before 10:00 am and after 4:00 pm
A new mother is attempting to breastfeed for the first time. The nurse notices that the client has inverted nipples. What nursing action can the nurse take to assist the client in breastfeeding the newborn?
Provide breast shells and assist the mother with using a breast pump before each feeding to make the nipples easier for the newborn to grasp.
The nurse is reviewing the record of a pregnant client and notes that the primary health care provider has documented the presence of Chadwick's sign. Which clinical finding supports the documentation of Chadwick's sign?
Violet bluish color of vaginal mucosa and cervix
A client diagnosed with chronic gastritis has been told that there is too little intrinsic factor being produced. The nurse should explain to the client that which therapy will be prescribed to treat the problem?
Vitamin B12 injections
The nurse is providing discharge teaching regarding skin care to a new mother of a 2-day-old infant. Which statements by the mother demonstrate an understanding of how to care for the infant's skin? Select all that apply.
"We will apply ointments containing zinc oxide to the baby's bottom to prevent diaper rash." "To prevent diaper rash, we will change our baby's diaper as soon as he has pooped or peed."
The nurse is reinforcing instructions to a 16-year-old male adolescent regarding dietary patterns. The nurse instructs the adolescent about the recommended amount of daily calories. How many calories a day does the nurse recommend as the approximate daily caloric allowance for a male adolescent?
2200
The nurse in the postpartum unit notes that the result of a rubella titer drawn on a postpartum client during the antepartum period is 1.8. Which should the nurse anticipate to be prescribed by the primary health care provider?
Administration of a subcutaneous rubella virus vaccine
The home care nurse is assigned to care for the client who returned home following treatment for a sprained ankle. The nurse notes that the client was sent home with crutches that have rubber axillary pads and needs to reinforce instructions regarding crutch walking. On data collection, the nurse discovers that the client has an allergy to latex. Before providing instructions regarding crutch walking, the nurse should do which action?
Cover the crutch pads with cloth
The pregnant woman complains of being awakened frequently by leg cramps. The nurse reinforces instructions to the client's partner and should tell the client to perform which measure?
Dorsiflex the client's foot while extending the knee.
A 1-year-old child with hypospadias is scheduled for surgery to correct this condition. The nurse is asked to assist in preparing a plan of care for this child. During this developmental time period, which factor should the nurse take into account?
Fears of separation and mutilation are present.
A nursing instructor asks a nursing student about the risk factors associated with osteoporosis. The instructor determines that the student needs further teaching if the student states that which is an associated risk factor?
High-calcium diet consumption
The nurse teaches the family of an infant with spina bifida that the infant should not be given which baby foods that may trigger a latex-type food allergy? Select all that apply.
Kiwi, bananas, avocados
The nurse is reinforcing instructions to a client about preterm labor. Which method of teaching should the nurse use?
Palpate for uterine contractions at the same time as the client.
The nurse is measuring the fundal height of a client who is at 30 weeks of gestation. In preparing to perform the procedure the nurse should take which action?
Place the client in a supine position and place a wedge under the right hip.
The nurse is assisting in providing a session to community members about the risks associated with laryngeal cancer. A client indicates an understanding of the risks by listing which factors? Select all that apply
Smoking cigarettes or cigars Drinking alcohol, especially daily Working in a dusty environment Persistent exposure to chemicals in the air Following a diet low in protein and vitamins
A pregnant client asks the nurse about the type of exercises that are allowable during the pregnancy. The nurse should instruct the client that which is the safest exercise?
Swimming
The client is prescribed oral erythromycin. The nurse should reinforce which instruction regarding the administration of this medication?
Take on an empty stomach.
The primary health care provider will perform a caloric test. Which is the priority order of the actions to perform this test? Arrange the actions in the order that they should be performed. All options must be used.
- Explain the purpose and procedure to the client - Note if the client has had central nervous system depressants, alcohol, or barbiturates - Check for the presence of nystagmus, postural deviation (Romberg sign), and past-pointing - Examine and clean the ear canal. - Place emesis basin under ear to be tested then irrigate the suspected ear with hot or cold water - Irrigate until the client complains of nausea and dizziness or nystagmus is observed
The nurse is assisting the primary health care provider with performing a Rinne tuning fork test on a client. The nurse expects that the steps of the testing will be performed in which priority order? Arrange the actions in the order that they would be performed. All options must be used.
- Tap tuning fork to activate - Place base of tuning fork on the mastoid bone. - Have client indicate when the sound disappears - Move the tuning fork close to the ear canal - Ask the client if he or she hears the sound and to indicate when the sound disappears. - Document whether bone or air conduction is better.
The client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition?
Vomiting following cancer chemotherapy