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Safe and Effective Care Environment Nclex PN Questions

Which of the following nursing diagnoses might be appropriate as Parkinson’s disease progresses and complications develop?

    A. Impaired Physical Mobility

    B. Dysreflexia

    C. Hypothermia

    D. Impaired Dentition

Correct Answer: Impaired Physical Mobility
Rationale: The correct answer is 'Impaired Physical Mobility.' As Parkinson’s disease progresses, clients may experience a shuffling gait and rigidity, leading to impaired physical mobility. This nursing diagnosis is relevant to address the functional limitations that may arise. 'Dysreflexia' is not typically associated with Parkinson's disease but rather with spinal cord injuries. 'Hypothermia' is a condition of abnormally low body temperature and is not a common complication of Parkinson's disease. 'Impaired Dentition' refers to dental issues and is not directly related to the progression of Parkinson's disease.

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.

Nonpharmacological pain management involves all of the following except:

  • A. hypnosis alone.
  • B. psychological care, including support groups.
  • C. physical and psychological modalities.
  • D. pain-reducing drugs only.

Correct Answer: pain-reducing drugs only.
Rationale: Nonpharmacological pain management encompasses various strategies like hypnosis, psychological care, and physical and psychological modalities. The correct answer is 'pain-reducing drugs only' because nonpharmacological approaches do not solely rely on medications for pain management. Options A, B, and C are all valid components of nonpharmacological pain management. Hypnosis can help manage pain, psychological care including support groups can provide emotional support and coping strategies, and physical and psychological modalities encompass a wide range of interventions beyond just medication.

An LPN is talking with a client scheduled to undergo a vasectomy in the next few minutes. He states, “I know I signed the form and all, but I’m not feeling so sure of this. It can be reversed pretty easily, right?” What is the LPN’s best response?

  • A. “Yes, vasectomies can be reversed, but once you have it, you may regret it later.”
  • B. “It’s normal to feel a little nervous before a procedure like this.”
  • C. “It sounds like you have a few more questions you’d like answered. Let me grab the doctor quickly so he can answer them for you.”
  • D. “It sounds like you might be a little nervous. Don’t worry, this is a pretty minor procedure, and the doctor doing it is the best we have. You’re in great hands.”

Correct Answer: “It sounds like you have a few more questions you’d like answered. Let me grab the doctor quickly so he can answer them for you.”
Rationale: The best response for the LPN is to acknowledge the client's concerns and offer to provide more information. By offering to get the doctor to answer any additional questions, the LPN shows respect for the client's right to informed consent. Option A provides some information but dismisses the client's uncertainty and implies they won't regret the decision, which may not be the case. Option B acknowledges nervousness but doesn't directly address the client's request for more information. Option D attempts to reassure the client but fails to address the need for additional questions to be answered by the doctor.

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: 6 liters/minute
Rationale: The correct answer is 6 liters/minute. When a client requires oxygen therapy, the maximum flow rate that oxygen can be delivered via nasal cannula is 6 liters/minute. Nasal cannula can effectively deliver oxygen up to 6 liters/minute. Flow rates exceeding 6 liters/minute may lead to drying of the nasal passages and discomfort for the client. Higher flow rates, like 8 liters/minute, should be administered using a mask to ensure sufficient oxygenation. Options A, B, and D are incorrect as they indicate flow rates that surpass the recommended maximum for nasal cannula delivery.

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