NCLEX Mock Review

A nurse is reinforcing instruction for a client with a recent leg fracture and cast. Which statements by the client indicate that further education is needed? Select all that apply.

"It's normal to have some numbness or tingling following a fracture." "It's normal to have severe pain even after the cast is on." "It's normal to have swelling and for the cast to feel really tight."

Which statement, made by a client with paranoid personality disorder, shows that education about social relationships is effective?

"Sometimes I can see what causes relationship problems."

A nurse is preparing to administer a preoperative intramuscular (IM) injection a 9-year-old child. Which size needle should the nurse select?

22G, 1-inch

The physician orders a stool culture to help diagnose a client with prolonged diarrhea. The nurse who obtains the stool specimen should:

collect the specimen in a sterile container.

A nurse is reinforcing education to a client with prostatitis who is receiving co-trimoxazole double strength. Which education is appropriate for this client?

Drink six to eight glasses of fluid daily while taking this medication

A nurse working in the triage area of an emergency department sees that several pediatric clients arrive simultaneously. Which child is treated first?

a 2-month-old infant with stridorous breath sounds, sitting up in his or her mother's arms and drooling.

The nurse prepares to administer morning medications to a client with hepatitis. The client's medications are listed below. Which medication should the nurse withhold?

acetaminophen 650 mg orally every day

When collecting data on a pregnant client with diabetes mellitus, the nurse stays alert for signs and symptoms of a vaginal or urinary tract infection (UTI). The nurse recognizes which condition makes this client more susceptible to such infections?

Glycosuria

The nurse is observing an infant who may have acute bacterial meningitis. Which finding should the nurse anticipate?

Irritability, fever, and vomiting

The nurse caring for a 3-day-old neonate notices that he looks slightly jaundiced. Although not a normal finding, it's an expected finding of physiologic jaundice and is caused by which of the following?

Large, immature liver

While examining a client's leg, the nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressings is most appropriate for the nurse to apply?

Moist sterile saline gauze

The nurse sees an unauthorized person reading a client's medical record outside a client's room. Which action should the nurse take?

Notify the nursing supervisor and approach the individual.

A nurse receives a report on a client who has been diagnosed with an abdominal aortic aneurysm (AAA). The nurse would expect the client to have which underlying disease?

atherosclerosis

A client is receiving captopril for heart failure. Which finding indicates that the medication isn't producing the desired treatment outcome and requires the nurse to notify the physician?

Peripheral edema

The nurse is caring for an infant who has undergone a surgical repair of a cleft lip. The health care provider prescribes elbow restraints. What nursing action should be included in the infant's plan of care?

Remove the restraints every 2 hours.

The nurse is caring for a child with symptomatic aortic stenosis. Which instruction should be provided to the child and parents.

Restrict exercise.

A client comes to the emergency department reporting visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension, a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension?

Untreated hypertension

The nurse is assisting with the development of a care plan for a postpartum client who had an uncomplicated vaginal birth of an 8-lb, 2-oz (3,693-g) neonate over an intact perineum 24 hours ago. While planning care for this client, the registered nurse collaborates with the licensed practical nurse to achieve which priority outcome in the next 8 hours?

encouraging the client to demonstrate an ability to breast-feed the neonate

A client diagnosed with major depression states, "Everything is my fault, and I would be better off dead." Which priority intervention would the nurse implement?

place the client on suicide precautions

A client comes to the emergency department with status asthmaticus. Based on the documentation note shown, the nurse suspects that the client has what abnormality?

respiratory alkalosis

Which finding would the nurse associate with a partial-thickness burn in a 9-year-old child? You Selected:

tissue necrosis through most of the dermis