NCLEX PN
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Free NCLEX PN Questions
The nurse is caring for a client who is receiving prescribed doxorubicin. Which of the following findings would indicate the client is having an adverse effect
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Urine discoloration
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Pulmonary congestion
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Hirsutism
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Pruritus
Explanation
Correct Answer B. Pulmonary congestion
Explanation:
Doxorubicin is a chemotherapy agent known for its potential to cause cardiotoxicity and pulmonary toxicity, including congestive heart failure and pulmonary congestion. Pulmonary congestion may indicate heart failure or cardiopulmonary adverse effects from the drug, requiring immediate attention.
Why Other Options Are Wrong:
A. Urine discoloration
Doxorubicin can cause reddish discoloration of urine, but this is an expected effect, not an adverse or harmful effect.
C. Hirsutism
Hirsutism (excessive hair growth) is not associated with doxorubicin use.
D. Pruritus
Pruritus (itching) is not a common adverse effect of doxorubicin.
When an elderly home health client suddenly develops delirium, what is the first thing the home health nurse should assess for
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Drug intoxication
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Increased hearing loss
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Cancer metastases
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Congestive heart failure
Explanation
Correct Answer A: Drug intoxication
Explanation:
Delirium in elderly clients is frequently caused by medication-related issues, including polypharmacy, drug toxicity, interactions, or newly added medications. The elderly are especially susceptible due to changes in pharmacokinetics and renal clearance. The first priority is to assess for drug intoxication, which is a common, reversible cause of sudden mental status changes. This includes reviewing all prescribed and over-the-counter medications, as well as any recent changes to the medication regimen.
Why Other Options Are Wrong:
B. Increased hearing loss
Although sensory impairment like hearing loss can contribute to confusion or social withdrawal, it typically leads to gradual changes, not acute delirium. Hearing loss may exacerbate communication difficulties but is unlikely to be the primary cause of sudden-onset confusion.
C. Cancer metastases
While metastases to the brain or other organs can cause neurological changes, this would not be the first issue to assess in a home setting without other obvious cancer-related symptoms. It is a more rare and less immediately reversible cause compared to drug-related delirium.
D. Congestive heart failure
CHF can contribute to hypoxia, which may lead to altered mental status in severe cases. However, it typically presents with accompanying symptoms like dyspnea, edema, or fatigue, and is less likely to be the initial cause considered unless cardiorespiratory signs are evident. Drug toxicity remains the most common and easily modifiable factor in sudden delirium.
The nurse in the pediatric unit is collecting data from several newly admitted clients. Which finding should the nurse follow up for possible abuse and mandatory reporting
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A 3-month-old with flat bluish discoloration on the buttock that the mother says has been present since birth
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A 3-year-old with forehead bruises that the mother says resulted from running into a table
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A 4-year-old who pulled boiling water off the stove and has splatter burns on the arms
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A 2-month-old who rolled off the changing table and is now lethargic
Explanation
Correct Answer D. A 2-month-old who rolled off the changing table and is now lethargic
Explanation:
A 2-month-old who rolled off the changing table and is now lethargic is the most concerning and requires follow-up for possible abuse. At this age, infants typically do not have the physical ability to roll over, making the explanation of the injury developmentally inconsistent. Lethargy is also a red flag for potential head trauma, such as abusive head injury (shaken baby syndrome). This situation meets the criteria for mandatory reporting due to the high suspicion of non-accidental trauma.
The nurse reinforces teaching about the use of the peak flow meter to evaluate airflow to a client newly diagnosed with asthma. Which statement by the client indicates an understanding of the nurse's teaching
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I will exhale a complete breath as quickly as possible through the mouthpiece of the device to obtain a peak flow reading.
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I will move the indicator to the desired reading on the numbered scale before using the device.
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I will record the lowest of 3 consecutive peak flow readings in my asthma journal every day.
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I will remember to use the device after taking my fluticasone via metered-dose inhaler.
Explanation
Correct Answer A. I will exhale a complete breath as quickly as possible through the mouthpiece of the device to obtain a peak flow reading.
Explanation:
Peak flow meters measure how fast air can be exhaled from the lungs. The client should first take a deep breath and then exhale forcefully and quickly through the mouthpiece to obtain a reading. This value reflects the degree of airway obstruction. Three attempts are typically made, and the highest value (not the lowest) is recorded. The test should be performed before taking bronchodilator medication, not after using inhaled corticosteroids like fluticasone.
The nurse is observing a staff member collecting a sputum specimen from a client with active tuberculosis. The nurse should intervene if the staff member is observed
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Leaving unused supplies in the client's room after the procedure
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Putting on clean gloves before putting on a protective gown
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Leaving a dedicated, disposable stethoscope in the client's room
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Putting on an N95 respirator mask and face shield before entering the client's room
Explanation
Correct Answer B. Putting on clean gloves before putting on a protective gown
Explanation:
The correct sequence for donning personal protective equipment (PPE) when entering the room of a client with airborne precautions (e.g., active tuberculosis) is:
Gown
N95 respirator (or PAPR)
Goggles or face shield
Gloves
Putting on gloves before the gown is incorrect because the gloves must cover the cuffs of the gown to provide a proper seal and prevent exposure to infectious material. Gloves over gown prevents contamination of the nurse's skin or clothing.
The nurse answers a call light on a client not assigned to the nurse. The client, who was just admitted from the emergency department, requests a cup of coffee. What is the appropriate intervention
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Allow a family member to bring the client a cup of coffee from the cafeteria
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Ask the client to wait until the health care provider's (HCP's) prescriptions can be verified
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Delegate the task to the unlicensed assistive personnel (UAP) assigned to the client
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Suggest water instead until admission assessment can be completed
Explanation
Correct Answer B. Ask the client to wait until the health care provider's (HCP's) prescriptions can be verified
Explanation:
Since the client was just admitted, important details such as NPO status, dietary restrictions, lab/imaging needs, or planned procedures may not yet be clarified. Offering coffee prematurely could risk violating orders or compromising patient safety (e.g., if the client is scheduled for surgery or tests requiring fasting). The safest and most appropriate response is to wait until the HCP's prescriptions are reviewed and the client's admission orders and diet status are confirmed.
The nurse prepares to administer the prescribed bupropion. Which two (2) teaching points should the nurse reinforce
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This medication may cause you to gain weight.
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You may notice a decreased libido while on this medicine.
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Have a diet that has a consistent intake of salt and water.
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You may have more energy with the medication.
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You will need ongoing laboratory work while on this medicine.
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Take this medication in the morning to prevent sleep problems.
Explanation
Correct Answer:
D. You may have more energy with the medication.
F. Take this medication in the morning to prevent sleep problems.
Explanation:
Bupropion is an atypical antidepressant that works by influencing the norepinephrine and dopamine pathways in the brain. Unlike selective serotonin reuptake inhibitors (SSRIs), bupropion tends to be stimulating rather than sedating. Because of its activating properties, it can help increase energy, which is beneficial for clients experiencing fatigue associated with depression. However, this stimulation can also contribute to insomnia, which is why clients are advised to take it in the morning to reduce sleep disturbances. These two points are essential for promoting adherence and minimizing discomfort associated with treatment.
Why Other Options Are Wrong:
A. This medication may cause you to gain weight.
This is incorrect. Bupropion is actually associated with weight loss rather than weight gain. This makes it a preferred option for clients concerned about weight gain with other antidepressants, such as mirtazapine or certain SSRIs.
B. You may notice a decreased libido while on this medicine.
This is incorrect. Bupropion is one of the few antidepressants that generally does not cause sexual side effects. In fact, it may even improve sexual function in some patients who experience dysfunction with other antidepressant therapies.
C. Have a diet that has a consistent intake of salt and water.
This is incorrect. This dietary recommendation is specific to lithium, which has a narrow therapeutic index and is influenced by sodium and fluid levels. Bupropion does not require dietary sodium or fluid monitoring.
E. You will need ongoing laboratory work while on this medicine.
This is incorrect. Routine laboratory monitoring is not necessary with bupropion therapy. In contrast, medications like lithium or valproic acid do require regular blood tests to monitor therapeutic levels and organ function.
The nurse is talking with the parents of an adolescent client who was brought to the emergency department after making superficial cuts on the arms with a razor blade. There are several cuts in various stages of healing on the client's forearms. Which of the following statements would be appropriate for the nurse to make
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This must be difficult for you.
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Everything is going to be all right.
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We have cleaned and bandaged the cuts.
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Why did you wait until now to bring your child here?
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Tell me about when you started noticing this behavior.
Explanation
Correct Answers:
A. This must be difficult for you.
C. We have cleaned and bandaged the cuts.
E. Tell me about when you started noticing this behavior.
Explanation
A. This must be difficult for you.
This statement acknowledges the parents’ emotional distress and shows empathy, helping to build rapport and trust during a sensitive conversation.
C. We have cleaned and bandaged the cuts.
This statement reassures the parents that the child’s immediate physical needs have been addressed. It provides essential factual information, helping to ease anxiety and shift the focus toward ongoing emotional and psychological support for the adolescent.
E. Tell me about when you started noticing this behavior.
This open-ended question invites the parents to share important context without judgment. It helps the nurse assess the duration and potential triggers of the self-harm, which is critical for safe planning and mental health referral. It also builds trust and supports collaborative care.
The licensed practical/vocational nurse (LPN/VN) has reinforced medication instructions to a client who has been prescribed a fentanyl transdermal patch. Which of the following statements, if made by the client, would indicate a correct understanding of the instructions
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I may still need pain medication while this patch is applied.
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If the patch comes loose, I may reinforce it with a piece of tape
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I can apply heat to the patch site to increase the pain relief.
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I should remove this patch while I am sleeping
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The patch will need to be changed every 72 hours
Explanation
Correct Answers:
A. I may still need pain medication while this patch is applied.
E. The patch will need to be changed every 72 hours.
Explanation:
The fentanyl transdermal patch delivers continuous opioid pain relief over 72 hours. Clients may require breakthrough pain medication during this period, especially if pain is not fully controlled. Patches are changed every 72 hours and should be applied to intact, non-irritated skin. Heat should never be applied as it increases absorption and risk of overdose.
A. I may still need pain medication while this patch is applied.
This is correct. Fentanyl patches provide baseline pain relief, but clients may still need additional medication for breakthrough pain, which is common and safe when monitored.
E. The patch will need to be changed every 72 hours.
This is correct. Fentanyl patches are designed to deliver a steady dose over 72 hours and should be replaced at the same interval unless otherwise directed by the provider.
Why Other Options Are Incorrect
B. “If the patch comes loose, I may reinforce it with a piece of tape.
Only manufacturer-approved adhesive film should be used if reinforcement is needed. Regular tape can affect absorption or damage the patch, posing a safety risk.
C. I can apply heat to the patch site to increase the pain relief.
Heat increases the absorption of fentanyl through the skin, which can lead to overdose and respiratory depression. It is a serious safety hazard and should be avoided.
D. I should remove this patch while I am sleeping.
The patch should remain in place continuously, including during sleep. Removing it disrupts the steady delivery of medication and can result in inadequate pain control.
A client with myocardial infarction underwent successful revascularization with stent placement, is now chest pain free, and will be attending cardiac rehabilitation as an outpatient. The client is embarrassed to talk to the health care provider about resuming sexual relations. What teaching should the nurse reinforce with this client
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Client may be ready for sexual activity if no symptoms occur when climbing 2 flights of stairs
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Client will be ready for sexual activity after completion of cardiac rehabilitation
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It will be 6 months before the heart is healthy enough for sexual activity
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Medications such as sildenafil or tadalafil are available as prescriptions from the health care provider
Explanation
Correct Answer A. Client may be ready for sexual activity if no symptoms occur when climbing 2 flights of stairs
Explanation of Correct Answer:
A. Client may be ready for sexual activity if no symptoms occur when climbing 2 flights of stairs:
Sexual activity places a similar physical demand on the heart as moderate exercise, like climbing two flights of stairs. If the client can perform this activity without chest pain, shortness of breath, or fatigue, they are generally considered medically stable enough to resume sexual activity. This is a common and practical guideline nurses use to help address client concerns safely and discreetly.
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