NCLEX RN

2. When administering an I.M. injection to an infant, the nurse in charge should use which site?

A. Deltoid
B. Dorsogluteal
C. Ventrogluteal
D. Vastus lateralis

14. A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. When the nurse locates the fundus, she notes that the uterus feels soft and boggy. Which of the following nursing interventions would be most appropriate initially?

A. Massage the fundus until it is firm.
B. Elevate the mother's legs.
C. Push on the uterus to assist in expressing clots.
D. Encourage the mother to void

A nurse receives a report at the beginning of a day shift.
Which client does the nurse evaluate first?

A) client reporting shortness of breath and difficulty breathing

B) client with a report of surgical incision pain of 4/10

C) client who reports difficulty sleeping through the night

D) client whose previous assessment included audible wheezing

The nurse cares for an immunocompromised adult client. The nurse reports which assessment finding as evidence of oral candidates?

A) fluid-filled blisters along the tongue and cheeks

B) white creamy patches on the tongue

C) unilateral neck swelling and fever

D) yellow, crusted lesions on the lips

nurse cares for a school age client admitted to the same day surgery center and scheduled to receive a gastronomy tube. What is the first action of the nurse?
A) Obtain vital signs and assess the clients health.

B) Educate the parent on the care of a gastronomy tube.

C) Ensure the parents have signed the informed consent form.

D) prepare the child for the procedure.

The nurse plans care for client immediately after reviewing the shift summary at 2300

Complete the diagram by selecting from the choices below to specify :

The condition the client is most likely experiencing

Two actions the nurse should take to address the condition and

Two parameters the nurse should monitor to assess the client's progress

NCLEX RN A nurse cares for a client with oral cancer and the placement of a percutaneous endoscopic gastronomy (PEG) tube for long- term enteral nutrition. The nurse educates the client and family on the care and use of the tube.

Which is the best action by the nurse when following the QSEN competencies of engaging the client and family in an active partnership to promote self-care management?

A) Give the client a pamphlet from the PEG tube manufacturer that explains the use, care and precautions of the tube and encourage the client to review the material

B) Explain to the client and family that a 16 French tube was inserted into the upper left quadrant of the abdomen and secured in the stomach by an internal bumper

C) Demonstrate measurement of the formula, filling and priming of the feeding system, the connection of tubing to the PEG tube, and the adjustment of the roller clamp to set the rate of feeding.

D) Educate the client and family on techniques to reduce the possibility of vomiting with intermittent feeding after the client experienced large emesis of formula.

The nurse cares for an immunocmpromised adult. The nurse reports which assessment finding as evidence of oral candidates?

A) white creamy patches on the tongue

B) fluid filled blisters along the tongue and cheeks

C) unilateral neck swelling and fever

D) yellow, crusted lesions on the lips

The nurse receives a phone call from a client reporting severe eye pain after accidentally spraying bathroom cleaner into the face a few minutes earlier. The nurse instructs the client to which action immediately?
A) Call the ophthalmologist for an urgent appointment.
B) Proceed to the emergency department.
C) Read the ingredients on the bottle to check for bleach.
D) litigate eyes with clean, tepid tap water.

NCLEX RN A nurse informs the provider of lab values for a client who was recently married at a routine gynecological visit. When the provider informs the client she is pregnant, the nurse understands which responses from the client would be related to the normally expected shock of pregnancy.
A) She States she is hesitant to tell her husband
B) She expresses anger regarding potential loss.

NCLEX RN
A client has experienced a traumatic amputation and subsequent body image disturbance. In the record, the nurse documents the nursing diagnosis of body image disturbance related to changes in appearance secondary to:

A) chronic disease
B) severe trauma
C) loss of body part
D) loss of body function