NCLEX-PN
Nclex Questions Management of Care
1. A client is diagnosed with HIV. Which of the following antiviral drug classes are used in the treatment of HIV/AIDS?
- A. nucleoside reverse transcriptase inhibitors
- B. protease inhibitors
- C. HIV fusion inhibitors
- D. all of the above
Correct answer: D
Rationale: All of the provided choices are antiviral drug classes used in the treatment of HIV/AIDS. Nucleoside reverse transcriptase inhibitors, such as tenofovir and emtricitabine, work by interfering with the virus's ability to replicate. Protease inhibitors, like atazanavir and darunavir, block an enzyme that HIV needs to make copies of itself. HIV fusion inhibitors, for instance, enfuvirtide, prevent HIV from entering human cells. Therefore, 'all of the above' is the correct answer as all the listed drug classes are commonly used in managing HIV infections. Choices A, B, and C are all essential components of antiretroviral therapy for HIV, targeting different stages of the virus's life cycle. The combination of drugs from these classes is often recommended to effectively control HIV replication and reduce viral load.
2. The nurse is teaching a client about sleep and gives background information on normal sleep patterns. Which of the following substances promotes sleep?
- A. serotonin
- B. cortisol
- C. alcohol
- D. narcotics
Correct answer: A
Rationale: Serotonin is a substance found in the body that promotes sleep. It plays a role in the synthesis of a hypnogenic factor that directly induces sleep. Cortisol is a stress hormone that can disrupt sleep patterns. Alcohol can disrupt REM sleep and negatively impact sleep quality. Narcotics, like alcohol, can interfere with sleep architecture and lead to poor quality sleep. Therefore, the correct answer is serotonin as it is associated with promoting sleep, while the other substances listed can have negative effects on sleep patterns.
3. Which of the following is not considered one of the five rights of medication administration?
- A. client
- B. drug
- C. dose
- D. routine
Correct answer: D
Rationale: The five rights of medication administration are dose, client, drug, route, and time. The correct answer is 'routine' as it is not commonly recognized as one of the essential rights in medication administration. Choice A, client, is necessary to ensure the right medication is administered to the right individual. Choice B, drug, is crucial to confirm the correct medication is given. Choice C, dose, is essential to ensure the right amount of medication is administered. Choice D, routine, is not typically included in the five rights of medication administration and is therefore the correct answer.
4. Which of the following statements describes the purpose of client restraint?
- A. Restraints are a nursing measure used to maintain client control.
- B. Restraints are an emergency intervention taken as a last resort to protect a client from imminent danger.
- C. Restraints are a therapeutic measure designed to positively reinforce client behavior.
- D. Restraints are an emergency measure that can only be taken by a nurse under the direct supervision of a physician.
Correct answer: B
Rationale: The correct answer is B. Restraints are used as an emergency intervention when all other options to protect a client from imminent danger have been exhausted. Restraints should only be used as a last resort to ensure the safety of the client and others. Choices A, C, and D are incorrect because restraints are not used to maintain control, reinforce behavior, or are exclusively taken under direct physician supervision. It is crucial to remember that restraint use should always be based on careful assessment, documentation, and adherence to legal and ethical guidelines.
5. When a client needs oxygen therapy, what is the highest flow rate that oxygen can be delivered via nasal cannula?
- A. 2 liters/minute
- B. 4 liters/minute
- C. 6 liters/minute
- D. 8 liters/minute
Correct answer: C
Rationale: The correct answer is 6 liters/minute. When a client needs oxygen therapy, the highest flow rate that oxygen can be delivered via nasal cannula is 6 liters/minute. Higher flow rates must be delivered by a mask. Choices A, B, and D are incorrect because they suggest flow rates that exceed what can be effectively delivered through a nasal cannula.
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