a nurse sees documentation in the clients record indicating that the health care provider has noted the presence of adventitious breath sounds the nur
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Nursing Elites

NCLEX-PN

Health Promotion and Maintenance NCLEX PN Questions

1. A nurse sees documentation in the client's record indicating that the health care provider has noted the presence of adventitious breath sounds. The nurse knows that these types of sounds have which aspect?

Correct answer: D

Rationale: Adventitious breath sounds are abnormal sounds that are not normally heard in the lungs. These sounds are added sounds superimposed on the breath sounds. They are caused by air colliding with secretions in the tracheobronchial passageways or when previously deflated airways pop open. Hollow sounds heard over the trachea and larynx are normal bronchial (tracheal) breath sounds, not adventitious. Rustling sounds heard over the peripheral lung fields are normal vesicular breath sounds, not adventitious. Therefore, the correct answer is that adventitious breath sounds are abnormal sounds that should not be heard in the lungs.

2. Which of the following would likely not impede learning?

Correct answer: C

Rationale: The correct answer is a client who states they are not interested. While lack of interest can hinder learning motivation, it is not a physical or mental barrier that directly impacts the learning process. On the other hand, a client who took AmbienĀ® an hour ago may experience drowsiness or impaired cognitive function, affecting their ability to learn. A bipolar client in a manic phase may exhibit symptoms such as racing thoughts, distractibility, and impulsivity, making it challenging for them to focus and engage in the learning process. A client with dysphagia may have difficulty swallowing, which can interfere with their ability to take oral medications or participate in activities that involve swallowing.

3. When obtaining a health history on a menopausal woman, which information should a nurse recognize as a contraindication for hormone replacement therapy?

Correct answer: D

Rationale: When considering hormone replacement therapy for a menopausal woman, unexplained vaginal bleeding should be recognized as a contraindication. This is because it could be indicative of a serious underlying condition that needs investigation before initiating hormone therapy. A family history of stroke, by itself, is not a contraindication for hormone replacement therapy, unless the woman herself has a history of stroke or blood-clotting events. Ovaries removed before age 45 may actually increase the likelihood of needing hormone replacement therapy due to early menopause. Frequent hot flashes and night sweats, on the other hand, are symptoms that can be relieved by hormone replacement therapy, making them a potential indication rather than a contraindication.

4. When meeting nurses for the first time, a new nurse manager makes eye contact, smiles, initiates conversation about their previous work experience, and encourages active participation. This behavior is an example of

Correct answer: D

Rationale: The nurse manager is demonstrating assertive behavior by confidently engaging with the nurses through eye contact, smiling, and encouraging participation. This behavior shows a balance between expressing her own opinions and respecting others. Aggressive behavior would involve dominating or embarrassing others, while passive behavior is characterized by being timid or nervous. Passive-aggressive behavior is indirect and manipulative, which is not demonstrated in this scenario.

5. A middle-aged woman tells the nurse that she has been experiencing irregular menses for the past six months. The nurse should assess the woman for other symptoms of:

Correct answer: C

Rationale: Perimenopause refers to a period in which hormonal changes occur gradually, ovarian function diminishes, and menses become irregular. It typically lasts around five years. In the case of the middle-aged woman experiencing irregular menses for six months, she aligns with perimenopause as it involves irregular menstrual cycles, one of the common symptoms during this transitional phase. Climacteric is a term describing the period of life with physiologic changes leading to the end of a woman's reproductive ability but not specifically characterized by irregular menses. Menopause marks the permanent cessation of menses and does not involve the transitional irregularities seen in perimenopause. Postmenopause is the phase after the completion of menopausal changes.

Similar Questions

A nurse is auscultating for vesicular breath sounds in a client. Of which quality would the nurse expect these normal breath sounds to be?
During a health assessment interview, the client tells the nurse that she has some vaginal drainage. The client is concerned that it may indicate a sexually transmitted infection (STI). Which statement should the nurse make to the client?
A nurse reviewing the physical assessment findings in a client's health care record notes documentation that the Phalen test caused numbness and burning. Which disorder does the nurse, on the basis of this finding, conclude that the client has?
Which of the following foods should be avoided by clients who are prone to developing heartburn as a result of gastroesophageal reflux disease (GERD)?
The LPN is caring for a client admitted for acute pancreatitis. Which of these medications would be the least appropriate for pain management?

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