NCLEX-PN
NCLEX PN Exam Cram
1. Which of the following is not typically considered one of the main mechanisms of Type II Diabetes treatment?
- A. Medications
- B. Nutrition
- C. Increased activity
- D. Continuous Insulin
Correct answer: Continuous Insulin
Rationale: Continuous Insulin is not typically considered one of the main mechanisms for treating Type II Diabetes. While medications, nutrition, and increased activity play crucial roles in managing Type II Diabetes, continuous insulin therapy is more common in Type I Diabetes or in specific cases of Type II Diabetes where other treatments are ineffective. Therefore, the correct answer is Continuous Insulin. Choices A, B, and C are mainstays in the treatment of Type II Diabetes, making them incorrect answers.
2. The nurse is caring for a client with decreased cardiac output secondary to heart failure with fluid volume overload. The effects of diminished renal perfusion will have which physiologic response?
- A. Diuresis
- B. Increased fluid retention
- C. Elevated bicarbonate level
- D. Paroxysmal idiopathic narcosis
Correct answer: B
Rationale: When there is diminished renal perfusion due to decreased cardiac output, the kidneys receive less blood flow. This leads to a decrease in urine output and an increase in fluid retention, as the kidneys are not able to effectively filter and excrete excess fluid. Elevated bicarbonate level and paroxysmal idiopathic narcosis are not typically associated with diminished renal perfusion in heart failure. Therefore, the correct answer is 'Increased fluid retention.'
3. How can the nurse promote relief of muscle pain, spasms, and tension?
- A. Encouraging the client to continue their activities as usual.
- B. Immobilizing the client.
- C. Applying heat, cold, pressure, or vibration to the painful area.
- D. Administering pain medication as needed to ease the muscle.
Correct answer: Applying heat, cold, pressure, or vibration to the painful area.
Rationale: To promote relief of muscle pain, spasms, and tension, the nurse should consider applying heat, cold, pressure, or vibration to the painful area. These interventions can help alleviate pain associated with muscle tension, pain, or spasms. Choice A is incorrect because encouraging the client to continue their activities as usual may exacerbate the pain. Choice B is incorrect as immobilizing the client may not address the underlying issue and could potentially lead to further complications. Choice D is also incorrect because while pain medication can be used, it is not the first-line treatment for muscle pain, spasms, and tension.
4. Which of the following goals is the most important for the nurse to address for a client admitted to the cardiac rehabilitation unit?
- A. Reduction of anxiety
- B. Referral to community resources
- C. Identification of lifestyle changes
- D. Verbalization of energy-conservation techniques
Correct answer: Identification of lifestyle changes
Rationale: The most important goal for a client admitted to the cardiac rehabilitation unit is the identification of lifestyle changes. This is crucial in promoting cardiovascular health and preventing future cardiac issues. Lifestyle changes such as diet modifications, exercise routines, smoking cessation, and stress management play a significant role in improving the overall cardiovascular well-being of the patient. While reducing anxiety, referring to community resources, and verbalizing energy-conservation techniques are all important aspects of care, identifying lifestyle changes is the primary focus in helping the client achieve long-term cardiovascular wellness.
5. A nurse is returning phone calls in a pediatric clinic. Which of the following reports most requires the nurse’s immediate attention and phone call?
- A. An 8-year-old boy has been vomiting, appears to have slower movements, and has a history of an atrioventricular shunt placement.
- B. A 10-year-old girl feels a dull pain in her abdomen after doing sit-ups in gym class.
- C. A 7-year-old boy has been having a low fever and headache for the past 3 days and has a history of an anterior knee wound.
- D. A 7-year-old girl who had a cast on her right ankle is complaining of itching.
Correct answer: An 8-year-old boy has been vomiting, appears to have slower movements, and has a history of an atrioventricular shunt placement.
Rationale: The correct answer is the 8-year-old boy with vomiting, slower movements, and a history of an atrioventricular shunt placement. This report requires immediate attention because the symptoms could indicate a blocked shunt, which is a serious medical condition needing urgent evaluation and intervention. Slower movements in the context of an atrioventricular shunt history could suggest increased intracranial pressure. The other choices involve less urgent issues: choice B describes post-exercise pain, choice C presents with a low-grade fever and headache that could be due to a mild infection, and choice D reports itching associated with a cast, which is a common issue and less critical compared to a potentially blocked shunt.
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