NCLEX NCLEX-RN Exam (page: 4)
NCLEX National Council Licensure Examination - -RN
Updated on: 25-Dec-2025

Viewing Page 4 of 345

Three weeks following discharge, a male client is readmitted to the psychiatric unit for depression. His wife stated that he had threatened to kill himself with a handgun. As the nurse admits him to the unit, he says, "I wish I were dead because I am worthless to everyone; I guess I am just no good." Which response by the nurse is most appropriate at this time?

  1. "I don't think you are worthless. I'm glad to see you, and we will help you."
  2. "Don't you think this is a sign of your illness?"
  3. "I know with your wife and new baby that you do have a lot to live for."
  4. "You've been feeling sad and alone for some time now?"

Answer(s): D

Explanation:

(A) This response does not acknowledge the client's feelings.
(B) This is a closed question and does not encourage communication.
(C) This response negates the client's feelings and does not require a response from the client. (D) This acknowledges the client's implied thoughts and feelings and encourages a response.



The nurse assists a client with advanced emphysema to the bathroom. The client becomes extremely short of breath while returning to bed. The nurse should:

  1. Increase his nasal O2 to 6 L/min
  2. Place him in a lateral Sims' position
  3. Encourage pursed-lip breathing
  4. Have him breathe into a paper bag

Answer(s): C

Explanation:

(A) Giving too high a concentration of O2 to a client with em-physema may remove his stimulus to breathe. (B) The client should sit forward with his hands on his knees or an overbed table and with shoulders elevated. (C) Pursed-lip breathing helps the client to blow off CO2 and to keep air passages open. (D) Covering the face of a client extremely short of breath may cause anxiety and further increase dyspnea.



The nurse assists a client with advanced emphysema to the bathroom. The client becomes extremely short of breath while returning to bed. The nurse should:

  1. Increase his nasal O2 to 6 L/min
  2. Place him in a lateral Sims' position
  3. Encourage pursed-lip breathing
  4. Have him breathe into a paper bag

Answer(s): C

Explanation:

(A) Giving too high a concentration of O2 to a client with em-physema may remove his stimulus to breathe. (B) The client should sit forward with his hands on his knees or an overbed table and with shoulders elevated. (C) Pursed-lip breathing helps the client to blow off CO2 and to keep air passages open. (D) Covering the face of a client extremely short of breath may cause anxiety and further increase dyspnea.



Which classification of drugs is contraindicated for the client with hypertrophic cardiomyopathy?

  1. Positive inotropes
  2. Vasodilators
  3. Diuretics
  4. Antidysrhythmics

Answer(s): A

Explanation:

(A) Positive inotropic agents should not be administered owing to their action of increasing myocardial contractility. Increased ventricular contractility would increase outflow tract obstruction in the client with hypertrophic cardiomyopathy. (B) Vasodilators are not typically prescribed but are not contraindicated. (C) Diuretics are used with caution to avoid causing hypovolemia. (D) Antidysrhythmics are typically needed to treat both atrial and ventricular dysrhythmias.



Which classification of drugs is contraindicated for the client with hypertrophic cardiomyopathy?

  1. Positive inotropes
  2. Vasodilators
  3. Diuretics
  4. Antidysrhythmics

Answer(s): A

Explanation:

(A) Positive inotropic agents should not be administered owing to their action of increasing myocardial contractility. Increased ventricular contractility would increase outflow tract obstruction in the client with hypertrophic cardiomyopathy. (B) Vasodilators are not typically prescribed but are not contraindicated. (C) Diuretics are used with caution to avoid causing hypovolemia. (D) Antidysrhythmics are typically needed to treat both atrial and ventricular dysrhythmias.



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