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100% Pass NCLEX - NCLEX-RN - National Council Licensure Examination(NCLEX-RN)–Professional Reliable Dump

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NCLEX National Council Licensure Examination(NCLEX-RN) Sample Questions (Q413-Q418):

NEW QUESTION # 413
A violent client remains in restraints for several hours. Which of the following interventions is most appropriate while he is in restraints?

A. Release restraints every 2 hours for client to exercise.
B. Assess skin integrity and circulation of extremities before applying restraints and as they are removed.
C. Give fluids if the client requests them.
D. Measure vital signs at least every 4 hours.

Answer: A

Explanation:
Explanation
(A) Fluids (nourishment) should be offered at regular intervals whether the client requests (or refuses) them or not. (B) Skin integrity and circulation of the extremities should be checked regularly while the client is restrained, not only before restraints are applied and after they are removed. (C) Vital signs should be checked at least every 2 hours. If the client remains agitated in restraints, vital signs should be monitored even more closely, perhaps every 1-2 hours. (D) Restraints should be released every 2 hours for exercise, one extremity at a time, to maintain muscle tone, skin and joint integrity, and circulation.

NEW QUESTION # 414
Which of the following serum laboratory values would the nurse monitor during gentamicin therapy?

A. Creatinine
B. Potassium
C. Calcium
D. Sodium

Answer: A

Explanation:
(A) A common side effect of gentamicin is nephrotoxicity. The serum laboratory test that best reflects kidney function is serum creatinine. (B) Serum sodium has no relationship to gentamicin. (C) Serum calcium has no relationship to gentamicin. (D) Serum potassium has no relationship to gentamicin. If a client has impaired renal function secondary to gentamicin administration, he or she may also have hyperkalemia as a secondary disorder.

NEW QUESTION # 415
Assessment of a client reveals a 30% loss of preillness weight, lanugo, and cessation of menses for 3 months.
Her vital signs are BP 90/50, P 96 bpm, respirations 30, and temperature 97 οF. She admits to the nurse that she has induced vomiting 3 times this morning, but she had to continue exercising to lose "just 5 more lb." Her symptoms are consistent with:

A. Anorexia nervosa
B. Gastritis
C. Bulimia
D. Pregnancy

Answer: A

Explanation:
Section: Questions Set F
Explanation:
(A) Presenting behaviors collectively are inconsistent with depression. (B) A preillness weight loss of 30%, lanugo, and cessation of menses are inconsistent with bulimia. (C) Symptoms and vital signs do not indicate the presence of infection. (D) All symptoms and vital signs are consistent with anorexia nervosa.

NEW QUESTION # 416
A 79-year-old client with Alzheimer's disease is exhibiting significant memory impairment, cognitive impairment, extremely impaired judgment in social situations, and agitation when placed in a new situation or around unfamiliar people. The nurse should include the following strategy in the client's care:

A. Maintain routines and usual structure and adhere to schedules.
B. Give the client two or three choices to decide what she wants to do.
C. Encourage the client to attend all structured activities on the unit, whether she wants to or not.
D. Ask the client to go to an activity once. If she gives no response right away, change the question around, asking the same thing.

Answer: A

Explanation:
Section: Questions Set C
Explanation:
(A) Alzheimer's clients cope poorly with changes in routine because of memory deficits. Schedule changes cause confusion and frustration, whereas adhering to schedules is helpful and supports orientation. (B) Insisting that the client go to all unit activities may antagonize her and increase her agitation because of cognitive impairments. It may be better to allow the client time for calming down or distraction rather than to insist that she attend every activity. (C) When repeating a question, allow time first for a response; then use the same words the second time to avoid further confusion. (D) The nurse should avoid giving several choices at once. Cognitively impaired clients will become more frustrated with making decisions.

NEW QUESTION # 417
A 42-year-old male client has been treated at an alcoholic rehabilitation center for physiological alcohol dependence. The nurse will be able to determine that he is preparing for discharge and is effectively coping with his problem when he shares with her the following information:

A. "I know that I can only drink one or two drinks at social gatherings in the future, but at least I don't have to continue AA."
B. "It really wasn't my fault that I had to come here. If my wife hadn't left, I wouldn't have needed those drinks."
C. "I really wasn't addicted to alcohol when I came here, I just needed some help dealing with my divorce."
D. "I know that I will not ever be able to socially drink alcohol again and will need the support of the AA group."

Answer: D

Explanation:
(A) The client has insight into the severity of his alcohol addiction and has chosen one of the most effective treatment strategies to support him-Alcoholics Anonymous. (B) The client is still using denial and is not dealing with his alcohol addiction. (C) The client is exhibiting denial about his alcohol addiction and projecting blame on his divorce. (D) The client is projecting blame onto his wife for being in the hospital while still denying his alcohol addiction.

NEW QUESTION # 418
......

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100% Pass NCLEX - NCLEX-RN - National Council Licensure Examination(NCLEX-RN)–Professional Reliable Dump

NCLEX-RN Latest Study Notes | Valid NCLEX-RN Exam Question

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Tony Lee Tony Lee

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100% Pass NCLEX - NCLEX-RN - National Council Licensure Examination(NCLEX-RN)–Professional Reliable Dump

NCLEX-RN Latest Study Notes | Valid NCLEX-RN Exam Question

NCLEX National Council Licensure Examination(NCLEX-RN) Sample Questions (Q413-Q418):

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