NCLEX Delegation Practice Questions (1-5)
Welcome to NCLEX Delegation Practice Questions. Before you begin answering the questions, you may first want to take a peek about the material that will surely help you the pass the NCLEX examination :
Enjoy answering and I hope that Nurse Certifications can somehow help you in your future examination.
1. A physician’s order reads to change digoxin (Lanoxin) 0.25mg intravenously daily to digoxin 0.25mg orally four times daily. The nurse takes which action first before initiating the new order?
a) check the client’s potassium level
b) calls the physician to question the order
c) checks the client’s apical pulse
d) checks the client’s serum digoxin level
2. A home care nurse is completing a plan of care for an older client who has hyperparathyroidism with severe osteoporosis. Which risk for nursing diagnosis would be the priority for this client?
a) risk for injury related to demineralization of bone that can lead to pathological fractures
b) imbalanced nutrition: less than body requirements, related to anorexia and nausea
c) risk for constipation related to the adverse effects of hypercalcemia on the gastrointestinal tract
d) ineffective therapeutic regimen management related to medication
3. A nurse is caring for a client who is mechanically ventilated. To which of the following client outcomes would the nurse assign the highest priority?
a) has no occurrence of aspiration
b) has pink, moist, intact mucous membranes
c) has an effective method of communication
d) has no evidence of infection
4. In preparing a client for a cardiac catheterization, it is most important that the nurse assess for a client’s history of:
a) allergy to shellfish
c) atrial fibrillation
d) cigarette smoking
5. A depressed female client tells the nurse that she feels powerless, unworthy of having friends, and on occasion she has taken too many pills. The nurse’s priority in planning care for this client is to:
a) continually assess the client for suicidal ideation
b) provide structured activities with other clients
c) monitor the effects of the prescribed tricyclic antidepressant
d) acknowledge the client’s accomplishments to build self-esteem
NCLEX Delegation Practice Questions
Answers and Rationale
– The usual maintenance dose of digoxin is 0.125 to 0.5 mg daily. The physician should be called because the order is written for four times daily, which would exceed the usual daily dose. This action is the priority, even though all of the other options are correct interventions before administering digoxin.
– The individual with hyperparathyroidism with severe osteoporosis would be at great risk for pathological fractures because of bone demineralization (option 1). Thus home safety would be a priority. Although options B, C, and D could be problematic for the client, the question does not specifically address these subjects. Nursing diagnoses are prioritized by urgency of the problem and the degree of harm to the client if untreated.
– Aspiration, mucous membrane lesions, ineffective communication, and infection are all possible complications for clients on mechanical ventilation. Aspiration takes the highest priority because it is the complication associated with maintaining a patent airway.
– Allergy to seafood, iodine, or iodine contrast media in the preprocedure period may necessitate a skin test for allergy severity and the use of prophylactic antihistamines to prevent an allergic response to the contrast medium. The other options are important parts of the client’s history, but are not specific to a cardiac catheterization procedure.
– Client safety always takes priority over other nursing care concerns. The other options are correct nursing measures that one would take with a depressed client, but they are not the priority.
After you reviewed your answers through its rationale, you can now proceed to the next set of questions:
NCLEX Delegation Practice Questions (6-10)