Study NCLEX PN Answers 99th Edition

Study NCLEX PN Answers 99th Edition

1. A client has a history of seizures. The physician ordered amitriptyline (Elavil) 25 mg three times daily. The nurse plans care knowing that the client is at risk for injury because of which adverse effect of amitriptyline?

A. Decreased platelet aggregation
B. Decreased seizure threshold
C. Decreased mental acuity
D. Depressed immunological system

Answer: B. Decreased seizure threshold

Rationale: Amitriptyline, a tricyclic antidepressant, lowers the seizure threshold, increasing the risk of seizures. This may not be the medication of choice for a client who is already at risk for seizure activity. Options 1, 3, and 4 are unrelated to the use of this medication.

Test-Taking Strategy: Note that the client has a history of seizures. Also noting the relation of the client’s diagnosis and option 2 will direct you to this option. Review the adverse effects of this medication if you had difficulty with this question.

Level of Cognitive Ability: Analysis

Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Mental Health
Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 418.

2. An adult client just admitted to the hospital with heart failure also has a history of diabetes mellitus. The nurse calls the physician to verify an order for which medication that the client was taking prior to admission?

A. NPH insulin
B. Chlorpropamide (Diabinese)
C. Regular insulin
D. Acarbose (Precose)

Answer: B. Chlorpropamide (Diabinese)

Rationale: Chlorpropamide is an oral hypoglycemic agent that exerts an antidiuretic effect and should be administered cautiously or avoided in the client with cardiac impairment or fluid retention. It is a first-generation sulfonylurea. Insulin does not cause or aggravate fluid retention. Acarbose is a miscellaneous oral hypoglycemic agent.

Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 3 first because they are similar. From the remaining options, recall that chlorpropamide causes fluid retention. This will direct you to option B. Review the adverse effects of chlorpropamide if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Adult Health/Endocrine
Reference: Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B. Saunders, pp. 608, 617.

3. A nurse is assisting in teaching a series of classes on maintaining a healthy pregnancy. The goal for the class is: “The pregnant woman will verbalize measures that may prevent traumatic conditions distressing to the fetus.” Based on this goal, which of the following would be a part of the teaching plan for this class?

A. Travel precautions and use of shoulder seat belts
B. Use of over-the-counter medications
C. Fetotoxic substances in the workplace
D. Effects of secondary cigarette smoke on the fetus

Answer: A. Travel precautions and use of shoulder seat belts

Rationale: Placental separation as a result of uterine distortion can occur from trauma, such as in car accidents. Placental separation decreases or shuts off uteroplacental circulation. Partial separation will result in fetal distress, with the distress increasing depending on the degree of separation. Complete separation leads to sudden severe fetal distress followed by fetal death. Use of the shoulder seat belt decreases the risk of placental separation by preventing the traumatic flexion of the woman’s body from sharp braking or impact, if an accident occurs.

Test-Taking Strategy: Note the issue of the question—traumatic conditions. Option 1 specifically addresses trauma from an injury such as a car or other vehicle accident. Options 2, 3, and 4 are also important teaching points but are not directly related to the issue of the question. Review measures to prevent trauma during pregnancy if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Planning
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, pp. 57-58.

4. A client with Parkinson’s disease “freezes” while ambulating, increasing the risk for falls. Which suggestion will the nurse include in the client’s plan of care to alleviate this problem?

A. Stand erect and use a cane to ambulate
B. Keep the feet close together while ambulating and using a walker
C. Consciously think about walking over imaginary lines on the floor
D. Use a wheelchair to move around

Answer: C. Consciously think about walking over imaginary lines on the floor

Rationale: Clients with Parkinson’s disease can develop bradykinesia (slow movement) or akinesia (freezing or no movement). Having these individuals imagine lines on the floor to step over can keep them moving forward. While standing erect and using a cane can help prevent falls, these measures will not help a person with akinesia move forward. Clients with Parkinson’s disease should walk with a wide gait, not with the feet close together. A wheelchair should be used only when the client can no longer ambulate with assistive devices such as canes or walkers.

Test-Taking Strategy: Focus on the issue—a plan for a client who “freezes” while ambulating. Visualize each option and note that option 3 encourages forward movement while ambulating. Review the special needs of the client with Parkinson’s disease if you had difficulty with this question.

Level of Cognitive Ability: Application
Client Needs: Safe, Effective Care Environment
Integrated Process: Nursing Process/Planning
Content Area: Adult Health/Neurological
Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, p. 630.

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