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Safe and Effective Care Environment Nclex PN Questions

What is mammography used to detect?

    A. pain

    B. tumor

    C. edema

    D. epilepsy

Correct Answer: tumor
Rationale: Mammography is a diagnostic imaging technique specifically designed to detect tumors, cysts, or other abnormalities in breast tissue. It is not used to detect pain, edema, or epilepsy. Pain is a symptom, not a condition that mammography can detect. Edema refers to swelling and is not detectable through mammography. Epilepsy is a neurological disorder, not a condition detected by mammography.

The LPN is assisting the client with an NG tube with activities of daily living. Which of these statements would indicate a need for teaching reinforcement?

  • A. “Since I’m not eating or drinking by mouth, I do not need to brush my teeth as often.”
  • B. “I should remain sitting up at a 45-degree angle or higher for 30 minutes after a feeding.”
  • C. “I can clean around the tube with water and mild soap.”
  • D. “I should avoid using Vaseline around the nostril and tube.”

Correct Answer: “Since I’m not eating or drinking by mouth, I do not need to brush my teeth as often.”
Rationale: The correct answer is, “Since I’m not eating or drinking by mouth, I do not need to brush my teeth as often.” This statement indicates a need for teaching reinforcement because even when an NG tube is in place, the client should still brush their teeth twice daily. Good oral hygiene is essential to reduce the risk of introducing bacteria that may cause an infection. Choice B is incorrect because remaining sitting up at a 45-degree angle or higher for 30 minutes after a feeding is a correct statement regarding NG tube care, promoting proper digestion and reducing the risk of aspiration. Choice C is also incorrect because cleaning around the tube with water and mild soap is an appropriate practice to maintain cleanliness and prevent infection. Choice D is incorrect because advising to avoid using Vaseline around the nostril and tube is a proper instruction to prevent skin breakdown, occlusion of the tube, and potential aspiration of Vaseline into the lungs.

Acyclovir (Zovirax) is the agent of choice for which of the following infections?

  • A. HIV
  • B. AIDS
  • C. candida
  • D. herpes

Correct Answer: herpes
Rationale: Acyclovir is an antiviral medication specifically effective in treating herpes infections. It works by inhibiting the replication of the herpes virus, shortening the duration of the infection. While Acyclovir can be used in HIV and AIDS patients to treat opportunistic viral infections, it is not a primary drug for managing HIV or AIDS itself. Candida is a type of fungus, and infections caused by Candida are treated with antifungal medications, not antivirals like Acyclovir. Therefore, the correct answer is herpes.

What intervention should the nurse take for a client who has sustained a hyphema?

  • A. Instruct the client to wear eye protectors in the future
  • B. Keep the client at bed rest, typically with the head of the bed propped up
  • C. Apply atropine eyedrops
  • D. Apply an ice pack to the site of injury

Correct Answer: Keep the client at bed rest, typically with the head of the bed propped up
Rationale: The correct intervention for a client who has sustained a hyphema is to keep them at bed rest, usually with the head of the bed raised. This positioning helps to reduce intraocular pressure and prevent further damage or rebleeding. Instructing the client to wear eye protectors in the future (Choice A) is not the immediate intervention required for a hyphema. Applying atropine eyedrops (Choice C) is not typically indicated for a hyphema. Applying an ice pack to the site of injury (Choice D) is not recommended for a hyphema as it can increase the risk of rebleeding. Therefore, the correct answer is to keep the client at bed rest.

A Roman Catholic client is preparing to have magnetic resonance imaging. He wants to wear his metal crucifix pendant while he is receiving the test. Which of the following is an appropriate response by the nurse?

  • A. “Because it gives you comfort, you may wear it.”
  • B. “It is a violation of religious rights to forbid it.”
  • C. “I am sorry, but it is not safe for you to wear the crucifix during this test.”
  • D. “You may wear it because it is important to you.”

Correct Answer: “I am sorry, but it is not safe for you to wear the crucifix during this test.”
Rationale: No metal objects may be worn while receiving magnetic resonance imaging due to safety risks involved with the strong magnet. The correct response by the nurse should prioritize the safety of the client. Allowing the client to wear the metal crucifix poses a risk of injury or interference with the imaging process. Option A is not appropriate as safety takes precedence over comfort in this situation. Option B is incorrect as it does not address the safety concerns associated with wearing metal objects during an MRI. Option D is also incorrect as it fails to acknowledge the safety issue involved and instead focuses solely on the importance to the client. It is important for the nurse to offer alternative forms of spiritual support that do not pose a risk during the MRI procedure.

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