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NCLEX Basic Care and Comfort questions with correct answers.
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NCLEX Basic Care and Comfort questions with correct answers.
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NCLEX Basic Care and Comfort questions withcorrect answers
The primary healthcare provider (PHP) has prescribed a saline IM
injection for a client who requests pain medication every 2-3 hours.
What would be the nurse's best first action?
1. Administer the injection.
2. Take vital signs.
3. Question prescription with primary healthcare provider.
4. Notify the nursing supervisor. Correct Answer-3. Question
prescription with primary healthcare provider.
(3. Correct: A placebo is any medication or procedure that produces an
effect in clients resulting from its implicit or explicit intent and not from
its physical or chemical properties. An example would be a sugar pill or
injection of saline. Some professionals try to justify the use of placebos
to elicit the desirable placebo effect or in a misguided attempt to
determine if the client's pain is real. These reasons cannot be justified on
either a clinical or ethical basis, except in an approved research study. It
is deceptive and represents fraudulent and unethical treatment.
1. Incorrect: Giving a placebo is fraudulent and unethical treatment.
,2. Incorrect: Taking the vital signs does not take care of the problem of
giving a placebo.
4. Incorrect: First, the nurse should discuss the prescription with the
primary healthcare provider.)
Which suggestion should the nurse provide to a client reporting frequent
episodes of constipation?
1. Take a stool softener.
2. Increase intake of fruit in the diet.
3. Monitor elimination habits for the next week.
4. Rest after each meal. Correct Answer-2. Increase intake of fruit in the
diet.
(2. Correct: Increased fiber intake may help to establish regular
elimination habits.
1. Incorrect: Not the best initial suggestion. It's better to promote health
maintenance routines than to just go with a medication, which could be a
temporary fix.
,3. Incorrect: The nurse should make a suggestion that will assist the
client with normal elimination. This option does not suggest a way to fix
the problem.
4. Incorrect: Increased activity is likely to result in more normal
elimination. Resting after meals would not increase elimination
frequency.)
The nurse is administering medication to an elderly client who has no
visitors. The client takes the pills, and, as the client hands the medication
cup back to the nurse, grabs onto the nurse's hand tightly. What is the
most logical rationale for the client's action?
1. Confusion and disorientation.
2. Scared and lonely and grabs the nurse's hand for comfort.
3. Would like to talk with the nurse.
4. Would like to reminisce with the nurse. Correct Answer-2. Scared and
lonely and grabs the nurse's hand for comfort.
(2. Correct: This elderly client with no visitors is most likely scared and
lonely. The touch of the nurse's hand is comforting for the client.
1. Incorrect: There is no indication of confusion or disorientation.
, 3. Incorrect: Grabbing the nurse's hand indicates more than just a desire
to talk. This is indicative of needing comfort and personal touch.
4. Incorrect: There is no indication of a desire to reminisce from the
information in the question.)
A nurse has educated a client on crutch walking. Which statement by the
client would indicate to the nurse that the client needs further
instruction?
1. "I will not alter the height of my crutches."
2. "My body weight should be supported at the hand grips with my
elbows flexed at 30 degrees."
3. "When I rise from a chair, I should position my crutches on my
unaffected side."
4. "I will not lean on my crutches while standing." Correct Answer-3.
"When I rise from a chair, I should position my crutches on my
unaffected side."
(3. Correct: The client should position crutches on affected side when
sitting or rising from a chair. This will give the client more stability with
position changes.
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