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Let's Learning Questions of NCLEX PN with Answer 70th Edition
1. A client with a diagnosis of a recurrent major depression who is exhibiting psychotic features is admitted to the mental health unit. In an attempt to create a safe environment for the client, the nurse most importantly designs a plan of care that deals specifically with the client’s:
A. Altered thought processes
B. Potential lack of appetite
C. Inability to care for self
D. Lack of knowledge regarding the depression
Answer: A. Altered thought processes
Rationale: A recurrent major depression with psychotic features alerts the nurse that care must be planned to address both the major depression and the psychosis. Psychosis is defined as a state in which a person’s mental capacity to recognize reality, communicate, and relate to others is impaired, thus interfering with the person’s capacity to deal with life’s demands. Altered thought processes can include the presence of hallucinations and delusions.
Test-Taking Strategy: Focus on the diagnosis of the client and use the process of elimination. Note the key words psychotic features to assist in directing you to option A. Additionally, there is no data in the question that relates to the items in options 2, 3, or D. Review the needs of the client who is exhibiting psychotic features if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process/Planning
Content Area: Mental Health
Reference: Stuart, G., & Laraia, M. (2005). Principles & practice of psychiatric nursing (8th ed.). St. Louis: Mosby, pp. 112, 335.
2. A 30-week-gestation prenatal client with complaints of painless vaginal bleeding comes to the labor and birthing department of the hospital. The nurse prepares the client for which expected diagnostic procedure?
A. Pelvic examination
B. Chorionic villi sampling
C. Amniocentesis
D. Contraction stress test
Answer: D. Contraction stress test
Rationale: A client with painless vaginal bleeding is at risk for going into labor, and a contraction stress test is indicated. The concern is that fetal oxygenation is only marginally adequate when the uterus is at rest; it may be decreased further during uterine contractions. Options 2 and 3 are not appropriate at this time. A pelvic examination is contraindicated when there is vaginal bleeding.
Test-Taking Strategy: Use the process of elimination focusing on the client’s symptoms and the purposes of the specific diagnostic tests identified in the options. Noting that the client has vaginal bleeding will assist in eliminating options 1, 2, and C. Review care to the pregnant client who is bleeding vaginally if you had difficulty with this question.
Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Maternity/Intrapartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 70.
3. A client with tuberculosis will be treated with isoniazid and rifampin (Rifadin). The nurse is preparing instructions for the client regarding these medications. Which statement would the nurse plan to provide to the client?
A. “You must discontinue the medication if gastrointestinal (GI) irritation occurs.”
B. “You must take the medication with meals.”
C. “The entire year-long course of the medication needs to be completed.”
D. “Fluids must be increased while taking this medication to prevent renal failure.”
Answer: C. “The entire year-long course of the medication needs to be completed.”
Rationale: The client needs to be instructed that the entire year-long course of the medication needs to be completed. It is preferable to take the medication 1 hour before or 2 hours after meals. If GI irritation occurs, the medication should not be discontinued, and in this situation a small amount of food may be taken to reduce the irritation. It is not necessary to increase fluids during this medication therapy.
Test-Taking Strategy: Use the process of elimination to answer the question. Note that options 1, 3, and 4 contain the absolute words “must.” Review the client teaching points related to these medications if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Safe, Effective Care Environment
Integrated Process: Teaching/Learning
Content Area: Pharmacology
Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, pp. 1056-1057, 1060.
4. Schizophrenia is diagnosed in a client. The nurse is asked to assist in preparing a nursing care plan for the client. In the planning, the nurse understands that it is most important that:
A. Allowing the client to set the goals for the plan of care is a priority
B. Until the client's thinking is cleared, the nurse may need to assist the client with grooming and nutrition
C. Refraining from pointing out the inconsistencies of the client's communication is essential to initial treatment
D. Letting the client act out and using the quiet room and restraints will be required initially
Answer: B. Until the client's thinking is cleared, the nurse may need to assist the client with grooming and nutrition
Rationale: As the nurse plans care for the schizophrenic client, it is important to understand the client's developmental stage and ability to accept the disease. Because of the severe decompensation in thinking, the client lacks insight and may not even acknowledge illness. In the acute phase, the nurse will take the lead in planning for the client's basic human needs, such as nutrition, hygiene, sleep, and activities of daily living (ADL). Options 1, 3, and 4 are incorrect.
Test-Taking Strategy: Focus on the client’s diagnosis and use the process of elimination. Using Maslow’s Hierarchy of Needs theory and recalling that it is important to assist the client in meeting basic needs will direct you to option B. Review care to the client with schizophrenia if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process/Planning
Content Area: Mental Health
Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 345.
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