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Study set 1 for RN NCLEX (Kaplan) Exam Questions With Correct Answers

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Study set 1 for RN NCLEX (Kaplan) Exam Questions With Correct Answers The family member of a client calls to ask the nurse to visit the client. The family member tells the nurse the client is refusing to seek medical attention for severe midsternal chest pain. Which activity will the nurse perf...

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  • October 21, 2024
  • 81
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • Rn nclex
  • Rn nclex
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©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM



Study set 1 for RN NCLEX (Kaplan) Exam
Questions With Correct Answers




The family member of a client calls to ask the nurse to visit the client. The family member tells

the nurse the client is refusing to seek medical attention for severe midsternal chest pain. Which

activity will the nurse perform first?




1. Go to the client's home with a stethoscope and blood pressure cuff.

2. Contact the client and report being asked to visit by a family member.

3. Contact 911.


4. Ask the family member if there are color changes and dyspnea. - answer✔1) INCORRECT -

The nurse needs permission before assisting the client. The nurse should not just arrive and

expect to be able to assess the client.

2) CORRECT - The nurse needs to make sure the client wants assistance and will give

permission for the nurse to enter the home.

, ©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM


3) INCORRECT - The client must be willing to accept emergency services before a call to 911

for help.

4) INCORRECT - The client needs to be assessed directly and not through information being

provided by the family member.




*Think Like A Nurse: Clinical Decision Making*

Before taking action on the family's request, the nurse needs to recall principles of safe, ethical

nursing practice. One of the principles is that of client autonomy. The client should be supported

in any health care decisions that are made, regardless of the feelings of others. Even though the

family is concerned about the client's symptoms, the client is refusing care and the nurse should

recognize the client's right to do so. The nurse should not arrive to the client's home without first

contacting the client and asking for permission to visit and complete an assessment.




*Content Refresher:* Beneficence is compassion, taking positive actions to help others, and the

desire to do good. Beneficence is a core principle of client advocacy. Nurses have the

foundational moral imperative of doing right. Before acting with beneficence, the nurse must

consider the client's wants and needs for his or her best life. The client's right to autonomy

should also be considered. Assess whether the treatment option or the decision to decline

treatment is congruent with promoting good for the client. Protect clients from harm by

providing safe and ethical nursing practice.

, ©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM


The nurse provides care to a client diagnosed with severe liver disease. Which intervention is

appropriate for the nurse to include in this client's plan of care?




1. Low-sodium IV albumin.

2. Sodium polystyrene sulfonate enemas.

3. Sengsteken-Blakemore tube.


4. Low-protein, high-carbohydrate diet. - answer✔1) INCORRECT - Low-sodium IV albumin is

used to balance osmotic pressure.

2) INCORRECT - Sodium polystyrene sulfonate enemas are used to treat hyperkalemia.

3) INCORRECT - A Sengsteken-Blakemore tube is used to apply pressure against bleeding

esophageal varices.

4) CORRECT - A low-protein, high-carbohydrate diet will help reduce the risks of hepatic coma

by reducing the level of ammonia that results from the breakdown of proteins.




*Think Like A Nurse: Clinical Decision Making*

The nurse knows from the study of anatomy and physiology that the liver has many functions, all

of which are important. When the liver is damaged through disease, some of these functions can

be affected. One important function of the liver involves the metabolism of protein. If the liver is

, ©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM


damaged, protein metabolism is adversely effected, increasing the client's risk of developing an

accumulation of ammonia in the body. To prevent this from occurring, the client will be

prescribed a low-protein diet. The nurse needs to reinforce dietary teaching to prevent

complications related to the client's diagnosis. The nurse knows from the study of nutrition that

to meet caloric and metabolic needs, the client's diet should be higher in carbohydrates.




*Content Refresher* When caring for a client with liver disease, the client should be weighed

daily at the same time, on the same scale and wearing the same type of clothing. In addition,

monitor intake and output, measure abdominal girth, assess for neck vein distention, monitor and

assess skin (specifically for jaundice), monitor level of consciousness, institute bleeding

precautions, monitor coagulation studies, place client in high-Fowler's position, provide low

sodium/low protein diet, and administer medications as prescribed. The nurse should also

monitor serum ammonia levels. A low protein, high ca

The nurse counsels an older client about peripheral vascular disease. Which client statement

indicates that further teaching is needed?




1. "I should not smoke since it makes my symptoms worse. "

2. "I should exercise, even if it causes pain. "

3. "I should use warm packs if my hands and feet get cold. "

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